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Keeping your smile healthy:
A Delta Dental recap

Preventive dental coverage is now a part of the benefit offerings available to you and your family if covered by a Purdue health plan. This coverage was added January 1, 2016, at no additional cost to you.

To better assist you in understanding the dental coverage options offered to you, we’ve outlined some helpful information below.

Preventive dental vs. buy-up coverage
Preventive dental coverage includes: two cleanings, a fluoride treatment (up to age 19), emergency palliative treatment and standard X-rays, with a combined, total maximum benefit of up to $500 per person – through Delta Dental at no additional cost to those enrolled in a Purdue health plan. The preventive benefit may be utilized with any dentist – in-network or out. Benefits will be paid based on the Delta Dental PPO Fee Schedule.

In addition to the preventive dental coverage, two plan options are available for purchase during open enrollment (in October) that provide additional coverage beyond the basic preventive care: PPO Standard and PPO Point of Service Plan. These plans are offered to all faculty and staff regardless of health plan choice, including to those who opt out of Purdue’s health coverage.

In all cases, the dental plan you participate in determines the level of coverage you receive on covered services from Delta Dental.

Dental networks and discounts
Within Delta Dental, you have access to two networks of participating dentists: Delta Dental PPO and Delta Dental Premier.

Dentists who participate in the Delta Dental PPO network have agreed to accept the Delta Dental PPO Fee Schedule amount as payment in full, providing you a 30 to 35 percent discount on covered services. This discount also applies for those who elect preventive coverage only and receive services beyond preventive care. Be sure to have the provider file the claim through Delta Dental for the discount to apply.

Delta Dental Premier dentists agree to the Maximum Approved Fee Schedule, this is the maximum amount Delta Dental has approved for a specific procedure performed by a Delta Dental Premier dentist. Dentists who participate in the Delta Dental Premier network offer approximately a 10 percent savings.

A dentist who does not participate in either the Delta Dental PPO or Delta Dental Premier network is considered a nonparticipating dentist. The Nonparticipating Dentist Fee is the maximum amount Delta Dental has approved for a specific procedure performed by a dentist who does not participate in the networks.

Purdue uses the Delta Dental PPO network as primary. Dentists who participate in the Delta Dental PPO network offer the greatest discount and you will notice:

  • They only charge you for your co-payment and deductible, if any; no balance billing.
  • Your out-of-pocket costs are likely to be less than the Premier network and nonparticipating dentists.
  • They submit claims on your behalf.

Purdue employees who utilize a dentist that participates in Delta’s Premier network receive some benefit toward their services. Dentists who participate in the Delta Dental Premier network generally offer a greater savings than nonparticipating dentists and you will notice:

  • They only charge you for your copayment and deductible, if any, plus the difference between the Delta Dental PPO fees and the Maximum Allowable fees.
  • Your out-of-pocket costs are likely to be lower than a nonparticipating dentist, but higher than using a Delta Dental PPO dentist.
  • They submit claims on your behalf.

Dentists who do not participate in a Delta Dental network:

  • Have not agreed to a reduced-fee schedule.
  • May charge you the full cost of a procedure.
  • May ask for payment in full up front.
  • Require you to pay up front. You will be responsible for making full payment to your dentist, and then Delta Dental will send you the check for covered service based on the Delta Dental PPO Fee Schedule.
  • May require you to submit your own claims.

 
Delta Dental PPO Dentist
Delta Dental Premier Dentist
Out-of-Network Dentist
Adult Cleaning Submitted Fee:
$80
$80
$80
Maximum Approval Fee:
-
$77
-
PPO Fee Schedule Amount:
$54
$54
$54
Coverage level:
100 percent
100 percent
100 percent
Amount Delta Dental Pays:
$54
$54
$54
AMOUNT YOU PAY:
$0
$23
$26

Crown Submitted Fee:
$950
$950
$950
Maximum Approval Fee:
-
$898
-
PPO Fee Schedule Amount:
$675
$675
$675
Coverage level:
50 percent
50 percent
50 percent
Amount Delta Dental Pays:
$337.50
$337.50
$337.50
AMOUNT YOU PAY:
$337.50
$560.50
$612.50


Resources

Find a participating dentist with Delta Dental (choose the “Delta Dental PPO” option under Network Selection).

Your dentist may ask for a Delta Dental ID number. The Delta Dental ID card has the “Client Number” and “Subscriber ID” listed on the card. The “Subscriber ID” is your PUID minus the first digit.

Create a Consumer Toolkit account with Delta Dental to view benefit coverage and eligibility details, print an ID card, see claims information and print a claim form.

For more dental plan coverage information, visit the Purdue Benefits website.

 
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