Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates
Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates
Delta Dental PPO™
-
Cost savings and a choice of dentists
Your Delta Dental PPO plan offers a large network of dentists plus savings on out-of-pocket costs for covered services.
- Save the most when you visit a Delta Dental PPO dentist
- You're free to visit any licensed dentist
- You pay only a percentage of the dentist's fee for covered services
- Enjoy low- or no-cost preventive care such as routine exams and cleanings
Get started
Set up your online account, log in and get familiar with your benefits.
Access your plan information anytime by creating an online account. You'll need your enrollee ID number — you can find this in your welcome letter or email. If you can't locate your enrollee ID number, enter your Social Security number with no dashes or spaces. Having trouble? Contact us.
After you log in, you can:
- Check eligibility and coverage for yourself and any dependents
- Find a dentist in the PPO network
- Get your plan ID card (though you don't need one to get care)
- Review details about past visits
- Go paperless and get your plan documents online
Your plan covers a wide array of of procedures, including preventive, basic and major services. To review your benefits details, log in to your account.
You'll also find your coinsurance percentage (your share of the cost) for covered procedures and the deductible (amount you need to pay before your plan begins to cover dental treatment — does not apply to diagnostic and preventive services). Remember that you'll need to pay any charges for non-covered services and amounts over the plan's annual maximum or the lifetime maximum for orthodontic services.
After each dental visit, you'll be able to find details about your claims and treatment.
Visiting the dentist
Choose a dentist that's right for your needs and understand how to minimize your out-of-pocket costs.
To locate a dentist in the Delta Dental PPO network, log in to your account and select Find a dentist. You can also search the online directory on our website by entering your location and selecting Delta Dental PPO from the drop-down list.
If you can't find a dentist in the PPO network, you can try searching the Delta Dental Premier® network. Keep in mind that your plan dollars won't go as far if you visit a Premier or out-of-network dentist.
Need a dentist that speaks your language or offers extended office hours? From the Find a dentist results page, choose Refine search to filter your search results and find dental offices that provide specific services and amenities.
Network dentists agree to offer services at lower negotiated rates. They're also highly credentialed and meet our strict quality standards, plus you won't have to submit claim forms or wait for reimbursement when you visit a network dentist.
Your plan dollars typically go the farthest when you visit a Delta Dental PPO dentist². Here's why:
- Lower dentists' fees. Fees that PPO dentists charge are usually lower than Premier dentists' fees and can be significantly lower than out-of-network dentists' fees, since these dentists are not under contract and can charge any amount.
- Higher benefit levels. With a PPO dentist, the amount the plan pays for covered procedures may be higher, so your share is lower. For example, a procedure that's covered at 80% coinsurance (you pay 20% of the bill) with a PPO dentist might only be covered at 60% when you visit a Premier dentist and 40% with an out-of-network dentist.
- Annual maximums go further. Your plan pays up to a certain amount for your benefits in any given year — this is the annual maximum — and after you reach that amount, you must pay out of pocket. When you visit dentists who charge higher rates, you'll reach your annual maximum sooner.
Your plan offers limited coverage if you or any covered dependents experience a dental emergency and need care from an out-of-network dentist. You may need to submit a claim form for reimbursement — if so, be sure to include the dentist's detailed billing statement that lists all services or procedures provided. For details about emergency coverage, refer to your plan booklet.
Get your estimated out-of-pocket expense for a procedure before you visit the dentist. Just log in to your account, select Plan ahead for a visit. and then choose Estimate costs. Select the procedure you need and answer any additional questions. You can also compare the fees of up to five dentists in your area.
If your plan doesn't include a cost estimator, you can request a pre-treatment estimate³ from your dentist, who will submit the estimate to us. We'll provide you with a copy that includes an estimate of your coverage and out-of-pocket costs.
After dental visits, find details about procedures you and your dependents have received, as well as your share of the cost, by logging into your account and selecting Claims & visits.
Other benefits
Learn about additional benefits your plan may offer and how to access them.
Orthodontic coverage varies depending on your plan, so be sure to log in to your account to review your coverage. Your orthodontist will submit any paperwork that's needed for pre-authorization, and they'll give you an initial estimate of costs associated with your treatment plan. For more details, review Get the facts straight (PDF, 157 KB).
If your plan includes orthodontic coverage and you (or a dependent) began orthodontic treatment under a previous dental plan, you may be able to continue treatment with the same orthodontist if banding has already been completed. Not all plans include orthodontic treatment in progress coverage, so be sure to review the benefits details in your online account or plan booklet.
Some Delta Dental PPO plans offer enhanced dental benefits each year if you or a covered dependent have been diagnosed with a chronic medical condition that affects oral health. If you qualify, you'll need to opt in to access this expanded coverage. Learn more about SmileWay Wellness Benefits.⁴
Some Delta Dental PPO plans offer additional dental benefits each year for those who have been diagnosed with a chronic medical condition that affects oral health. Here are the conditions that qualify for SmileWay Wellness Benefits⁴:
- Diabetes
- Heart disease
- HIV/AIDS
- Rheumatoid arthritis
- Stroke
(More conditions will be added soon.)
If your plan covers SmileWay Wellness Benefits, you and any dependents who qualify will receive additional benefits² on top of your plan's existing benefits. You may need to opt in to access the expanded coverage.
To determine if your plan offers SmileWay Wellness Benefits, log in to your account, select Benefits overview (or Benefits) and then Optional benefits. You can also contact us.
SmileWay Wellness Benefits
| Procedure | Procedure code³ | Additional coverage per |
|---|---|---|
| One periodontal scaling and root planing (deep cleaning to treat gum disease) — per quadrant | D4341 (4 or more teeth) D4342 (1 to 3 teeth) |
100% coverage |
| Plus up to four procedures from the following (any combination) | ||
|---|---|---|
| Prophylaxis (teeth cleaning) | D1110 (adult) D1120 (child) |
100% coverage |
| Periodontal maintenance (cleaning to monitor and treat inflammation and infection after past gum surgery or treatment) | D4910 |
100% coverage |
| Scaling in presence of moderate or severe gingival inflammation (plaque removal) | D4346 |
100% coverage |
Frequently asked questions
Find answers to common questions about Delta Dental PPO plans.
To view or print your ID card, log in to your account and select Get ID card. You can still visit the dentist without an ID card — your dental office can verify your coverage with your basic information — so you don't need one at all.
You do not need to download the app. You can access your online account through our mobile-friendly website to get your plan ID card and the most detailed information specific to your benefits. If you'd like to add your ID card to your phone's wallet, you can download the Delta Dental mobile app from the Apple App Store or Google Play. Note that the app may not include as many details about your benefits and out-of-pocket costs.
After the start date, your plan may require a waiting period for certain services, so be sure to review your benefits in your plan booklet. Waiting periods typically don't apply to diagnostic and preventive services.
You can check whether your dentist is in the Delta Dental PPO network — use our Find a dentist tool (or log in to your account) to search by your dentist's name or the practice name. If your dentist is not in the PPO network, you can try searching the Delta Dental Premier network. If so, just know that your plan dollars won't go as far when you continue to visit your current dentist.
If your dentist doesn't participate in either the PPO or Premier network, you may want to find a new dentist to make sure you maximize your savings.
You can always recommend your dentist to us and we'll invite them to join our PPO network (though this may not necessarily result in their participation).
Check your coinsurance amount for any covered procedure by logging in to your account and selecting Benefits details, or you can refer to your plan booklet. You may also be able to estimate your out-of-pocket cost for certain covered procedures from your account. Go to Plan ahead for a visit and select Estimate costs, then choose the procedure from the drop-down list and answer any additional questions. You can also compare the fees of up to five dentists in your area.
If your plan doesn't include a cost estimator, you can request a pre-treatment estimate³ from your dentist, who will submit the estimate to us and we'll provide you with a copy.
You don't need a referral to see a specialist. Be sure to visit a specialist in the PPO or Premier network to limit your out-of-pocket costs.
If you need to find a specialist, log in and search Find a dentist, then choose Refine search and filter the dentist list by the type of specialty you need. You can also ask your general dentist for a recommendation.
For most dental treatment that's in progress when your Delta Dental coverage begins, you or your previous carrier are responsible for the cost of completing the treatment. This includes, but is not limited to, root canals, crowns or bridge work.
For orthodontic treatment, some Delta Dental PPO plans include a treatment-in-progress provision that may allow you to continue visiting your current orthodontist to complete treatment. Find more details in the Orthodontic coverage section on this page and log in to check your coverage.
Your adult dependent first needs to authorize you to have access to their treatment details and other personal health information, per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To authorize you, your adult dependent must either submit a signed HIPAA authorization form (PDF, 38 KB) or log in to their online account and choose My account. They should choose Yes for the statement, "I authorize the primary member on this plan to view details about the dental services provided to me," then select Save.
- Delta Dental PPO™ plans are underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California; PA, MD – Delta Dental of Pennsylvania; NY – Delta Dental of New York, Inc.; DE – Delta Dental of Delaware, Inc.; WV – Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.
- PPO and Premier dentists won't bill you for any amount over their contracted fees. Non-Delta Dental dentists may bill the difference between their usual fee and Delta Dental's maximum contract allowance. You are responsible for any applicable deductibles, coinsurance, amounts over the annual or lifetime maximums and charges for non-covered services.
- A pre-treatment estimate is not a guarantee of Delta Dental’s final payment. When the treatment is complete, we will calculate our payment based on your current eligibility, applicable deductibles and maximums and any dual coverage you have.
- SmileWay Wellness Benefits are not included under all plans. Known as SmileWay® Enhanced Benefits in Texas.