The two plans offered to you are very different. As with any insurance plan, please make sure that you review the Plan Highlights & Benefit Summary before enrolling.
The information below is intended to help you understand some frequently asked questions, but it is still important for you to review the Plan Highlights & Benefit Summary in full before enrolling in either plan.
Is there a maximum benefit?
- DeltaCare: There is a $1,000 calendar year maximum (January-December) benefit per member for certain specialty services (endodontic services, periodontic services, and oral surgery). There is no maximum benefit for other covered services outlined in the plan summary. The frequency of certain services, however, is limited. Please refer to the frequency limitations and exclusions sections of the plan summary for details on those limitations.
- Total Choice PPO: There is a $1,000 calendar year maximum (January-December) benefit per member. This maximum applies to all covered services on the plan summary. The frequency of certain services is also limited. Please refer to the frequency limitations outlined in the benefit summary: Example Teeth Cleaning-Once every six months.
How do I find a participating dentist?
- Delta Dental has a variety of networks. Do not assume that because a dentist accepts "Delta Dental" that he/she is a contracted provider that accepts the Delta Dental Fees for services. Ask the providers office are they a “contracted dentist” under the dental network that you have chosen either the DeltaCare or the Total Choice PPO Network. The two dental plans offered to you use different Delta Dental networks as described. You can search for participating providers at http://www.deltadentalma.com/Members/. Please be careful to select the correct Delta Dental network when searching the directory (DeltaCare and/or Total Choice PPO Networks).
- DeltaCare: This plan uses the DeltaCare Provider Network only. When choosing a Primary Care Dentist (PCD) you MUST select one in the DeltaCare network. Dentists in the DeltaCare network are only located in Massachusetts. If you enter a dentist who does not accept the DeltaCare plan, your selection will be voided and Delta Dental will reassign you to a contracted dentist within the DeltaCare network based on your home address. Please note that you can change your DeltaCare Provider at any time by calling DeltaCare at 800-327-6277. Changes must be made no later (preferably earlier) 18th of the month to be effective on the 1st of the following month.
- Delta Dental Total Choice PPO Network: This plan utilizes the Delta Dental Total Choice PPO Network. As a member you benefit from having access to the largest PPO network in the state.
- Delta Dental Total Choice PPO, with more than 4,000 participating dentist locations you will enjoy the greatest out-of-pocket savings when visiting Delta Dental Total Choice PPO Network dentists as part of the in-network services outlined in the plan summary at the following coinsurances: 100%, 80% and 50%.
- The Delta Dental Total Choice PPO Network has participating providers across the state of Massachusetts and offers discounted fees. You do not need to select a primary care dentist under the network. Visit our web site at www.totalchoiceppo.com.