Delta Dental PPO Plus Premier - Lexingtonky.gov
Delta Dental PPOPlus PremierOur nationalPreferred ProviderProgramWelcome!Your dental program is administered by Delta Dental of Kentucky, Inc., a Kentucky not-for-profit dental servicecorporation. Delta Dental of Kentucky is the Commonwealth’s dental benefits specialist. Good oral health is a vitalpart of good general health, and your Delta Dental program is designed to promote regular dental visits. We encourageyou to take advantage of this program by calling your Dentist today for an appointment.This Certificate, along with your Summary of Dental Plan Benefits, describes the specific benefits of your DeltaDental program and how to use them. If you have any questions about this program, please call our Customer Servicedepartment at (800) 955-2030 or access our website at www.deltadentalky.com.You can easily verify your own benefits, claims and eligibility information online 24 hours a day, seven days a weekby visiting www.deltadentalky.com and selecting the Consumer Toolkit. The Consumer Toolkit will also allow you toprint claim forms, ID cards, explanation of benefits (EOBs), review your claims status, choose to receive paperlessEOBs, search our Dentist directories, read oral health tips and more.We look forward to serving you!2013-003-DD
TABLE OF CONTENTS1.Certificate . . 22.Definitions.23.Selecting a Dentist .54.Accessing Your Benefits .65.How Claim Payment is Made .76.Benefit Categories .87.Exclusions and Limitations .98.Coordination of Benefits .139.Claims Appeal Procedure .1510.Termination of Coverage .1611.Continuation of Coverage .1612.General Provisions .17Note: Please read this Certificate with the Summary of Dental Plan Benefits. The Summary of DentalPlan Benefits lists the specific provisions of your group dental Plan. If a statement in the Summaryconflicts with a statement in this Certificate, the statement in the Summary applies to this Plan and youshould ignore the conflicting statement in this Certificate.12013-003-DD
treatment. If the dental procedure used is differentfrom the procedure covered under this Certificate, theDentist may bill the patient for the difference betweenthe Maximum Approved Fee for the service providedand the amount paid by Delta Dental for the claim.1. Delta Dental PPOPlus PremierCertificateBenefit YearDelta Dental of Kentucky, Inc., issues this Certificateto you, the Subscriber. The Certificate is a summary ofyour dental benefits coverage. It reflects and is subjectto a contract between Delta Dental and your employeror organization.The annual period of your coverage as shown in theSummary of Dental Plan Benefits. Your Benefit Yearends at the same time your coverage ends.BenefitsThe Benefits provided under This Plan are subject tochange as required by any state or federal law.Payment for the Covered Services under This Plan.CertificateDelta Dental agrees to provide Benefits as described inthis Certificate and the Summary of Dental PlanBenefits.This document is your Certificate of Coverage. DeltaDental will provide Benefits as described in thisCertificate and the Summary of Dental Plan Benefits.Any changes in this Certificate will be based onchanges to the contract between Delta Dental and yourGroup. The Certificate may also be referred to as ThisPlan.Cliff Maesaka, Jr. DDSPresident and CEODelta Dental of Kentucky, Inc.Children or Child2. DefinitionsYour natural children; stepchildren; adopted children;children by virtue of legal guardianship; or childrenwho reside with you during the waiting period foradoption or legal guardianship.This section defines terms having specialmeanings in the Certificate and Summary ofDental Plan Benefits. A word or phrasestarting with a capital letter has a specialmeaning. It is defined either in this Definitionssection or in the text itself.Completion DatesThe date that treatment is complete. Some proceduresmay require more than one appointment before theycan be completed. Treatment is complete:Adverse Benefit Determination For dentures and partial dentures, on thedelivery dates;Any denial, reduction or termination of the benefits forwhich you filed a claim; or any failure to makepayment (in whole or in part) for the benefits yousought, including any determination based oneligibility. For crowns and bridgework, on the permanentcementation date; For root canals and periodontal treatment, on thedate of the final procedure that completes treatment.Alternate Benefit For appliances, on the date the appliance is placed.A Benefit provided in cases where alternative methodsof treatment exist for the same Dental Service. In thiscase, Benefits are provided for the least costly,professionally acceptable treatment. This is adetermination of Benefits under this Plan. It is not arecommendation of which service should be provided.The Dentist and patient should decide the course of For implants, on the date the implant is placed.CopaymentThe percentage of the bill that you are responsible forafter you have met your Deductible, if any. Please refer22013-003-DD
to The Summary of Dental Benefits for percentages andDeductibles.Delta Dental PremierCosmetic DentistryDelta Dental’s national managed fee-for-servicedental benefits program.Any procedure that is for general appearance and isnot caused by disease, prevention, diagnosis, injury,decay, fracture or orthodontic correction.Dental ServicesAny service, treatment or care you receive from adental professional. Any dental procedure ormaterials related to the procedure. A Dental Servicemay or may not be a Covered Service.Covered ServicesThe Dental Services shown in your Summary of DentalPlan Benefits are the Covered Services that will be paidunder This Plan. The Covered Services must be providedby or under the direction of a Dentist. Covered Servicesincludes services that are not reimbursed because of aDeductible, Copayment, waiting period, MaximumPayment, frequency, or other limit.DentistA person licensed to practice dentistry in the state inwhich dental services are performed.DeductibleThe amounts a person or a family as a whole must paytoward Covered Services before Delta Dental beginspaying for those services. The Summary of DentalPlan Benefits lists the Deductibles, if any, that apply toyou and your family. The individual Deductibles applytoward the family Deductible. No Eligible Person paysmore than the individual Deductible for that personwhile the total of Deductibles for all Eligible Personsin the family cannot exceed the family Deductible.Delta Dental Delta Dental PPO Dentist (“PPO Dentist”) is aDentist who has signed an agreement in his or herstate to participate in Delta Dental PPO. PPODentists agree to accept Delta Dental’s payment,your Copayment and Deductible, if any, aspayment in full for Covered Services.Delta Dental of Kentucky, Inc., a Kentucky not-forprofit dental service corporation that provides dentalbenefits to its Subscribers.Delta Dental PlanA Delta Dental company that is a member of the DeltaDental Plans Association, the nation’s largest, mostexperienced system of dental health plans. Delta Dental Premier Dentist (“PremierDentist”) is a Dentist who has signed anagreement in his or her state to participate in DeltaDental Premier. Premier Dentists agree to acceptthe Maximum Approved Fee as payment in full forCovered Services.Delta Dental PPODelta Dental’s national preferred provider organizationprogram that can reduce your out-of-pocket expensesif you receive care from a Delta Dental PPO Dentist. Non-participating Dentist is a Dentist who hasnot signed an agreement with any Delta DentalPlan to participate in Delta Dental PPO or DeltaDental Premier.Delta Dental PPO Plus Premier Out-of-Country Dentist is a Dentist whose officeis located outside the United States and itsterritories. Out-of-Country Dentists are not eligibleto sign participating agreements with Delta Dental.This program offers the Delta Dental PPO plan andalso has back-up coverage through Delta DentalPremier that will pay at the Premier Dentist Schedule.32013-003-DD
PPO Dentists and Premier Dentists are sometimescollectively referred to as “Participating Dentists.”Wherever a definition or provision of this Certificatediffers from another state’s Delta Dental Plan and itsagreement with Participating Dentists, the agreementin that state with that Dentist will be controlling.Effective DateNon-participating Dentists, and Out-of-CountryDentists are sometimes collectively referred to as“Non-participating Dentists.” Non-participatingDentists may bill you for the difference between theamount charged and the Maximum Approved Fee inaddition to Deductibles, Copayments and charges forNon-Covered Services.Any Subscriber or Eligible Dependent with coverageunder This Plan.Eligible Dependent(s)InvestigationalThe Summary of Dental Plan Benefits has specificinformation about This Plan’s rules for dependenteligibility, but generally, your Eligible Dependentsare:A device, treatment, procedure or service that is beingstudied to determine if it should be used for patient care.We reserve the sole right to determine what isInvestigational. Approval by the Food and DrugAdministration (FDA) does not mean that we approvethe service. Devices and any services involved in clinicaltrials are Investigational.The date on which your coverage under your Groupcontract begins.Eligible PersonGroupThe employer, trust or other plan sponsor that has enteredinto a contract with Delta Dental. Your legal spouse or domestic partner. Pleasecheck the Summary of Dental Plan Benefits forcoverage;Maximum Approved Fee Your unmarried Children living with you. Pleaserefer to your Summary of Dental Plan Benefits forspecific age limits of This Plan;The maximum amount a Participating Dentist cancharge the patient and Delta Dental combined for aCovered Service. The Maximum Approved Feerequirements are the lowest of: Any unmarried Children for whom you or yourlegal spouse are financially responsible for theirmedical or dental care under the terms of a courtdecree or who have been named as alternaterecipients under a Qualified Medical ChildSupport Order (QMCSO); The Submitted Amount; The lowest fee regularly charged, offered or receivedby an individual Dentist for a dental service,regardless of the Dentist’s contract with anotherdental benefits organization; Your Children who have reached the age specifiedin your Summary of Dental Plan Benefits, but whoare totally and permanently disabled by a physicaland/or mental condition. You must submit medicalreports confirming the Child’s initial or continuingtotal disability; The maximum fee that the local Delta Dental Planapproves for a given procedure in a given regionor specialty, under normal circumstances, basedupon applicable Participating Dentist schedulesand internal procedures. Your child, a post-secondary, full-time student whohas taken a medically necessary leave of absencefrom the school due to a serious illness or injury.Coverage is extended up to one year during suchleave of absence;Participating Dentists are not allowed to charge DeltaDental patients more than the Maximum ApprovedFee for a Covered Service. In all cases, Delta Dentalwill make the final determination regarding theMaximum Approved Fee for a Covered Service.These definitions and age limits of Eligible Dependentsmay be superseded by any applicable state and/or federallaws.42013-003-DD
A Pre-Treatment Estimate is not a claim for Benefits,pre-authorization, pre-certification, or reservation offuture Benefits.Maximum PaymentThe maximum dollar amount Delta Dental will pay inany Benefit Year or lifetime for Covered Services.Maximum Payment amounts are described in theSummary of Dental Plan Benefits.Premier Dentist ScheduleNonparticipating Dentist FeeThe maximum fee allowed per procedure for servicesrendered by a Premier Dentist as determined by thatDentist’s local Delta Dental Plan.The maximum fee allowed per procedure for servicesrendered by a Nonparticipating Dentist.Processing PoliciesDelta Dental’s policies and guidelines used for PreTreatment Estimates and payment of claims. TheProcessing Policies may be amended from time totime.Non-Covered ServiceA Non-Covered Service is any Dental Service that isnot a Covered Service.Submitted AmountOpen Enrollment PeriodThe period of time, as determined by your employer ororganization, during which an eligible person mayenroll or be enrolled for Benefits. Open Enrollment isheld once in a 12-month period.The amount a Dentist bills for a specific treatment orservice. A Participating Dentist cannot charge you oryour Eligible Dependents for the difference betweenthis amount and the Maximum Approved Fee forCovered Services.Out-of-Country Dentist FeeSubscriberThe maximum fee allowed per procedure for servicesrendered by an Out-of-Country Dentist.You, when your employer or organization notifiesDelta Dental that you are eligible to receive dentalbenefits under This Plan.PPO Dentist ScheduleSummary of Dental Plan BenefitsThe maximum fee allowed per procedure for servicesrendered by a PPO Dentist as determined by thatDentist’s local Delta Dental Plan.A description of the specific provisions of yourGroup dental coverage. The Summary of DentalPlan Benefits is, and should be read as, a part of thisCertificate, and supersedes any contrary provisionof this Certificate.Pre-Treatment EstimateA process where Delta Dental issues a written estimateof dental benefits, which may be available under yourcoverage for proposed dental treatment. Your Dentistmay submit a request for a Pre-Treatment Estimate inadvance of providing the treatment.This PlanThe dental coverage established for Eligible Personspursuant to this Certificate including the Summary ofDental Plan Benefits.A Pre-Treatment Estimate can be provided at your oryour Dentist’s request and is provided forinformational purposes only. It is not required beforeyou receive any dental care or for approval of futuredental benefits payment. You will receive the samebenefits under This Plan whether or not a PreTreatment Estimate is requested. The benefit providedon a Pre-Treatment Estimate notice is based on yourcoverage on the date the notice is issued. It is not aguarantee of future dental benefits or payment.3. Selecting a DentistYou may choose any Dentist. Your out-of-pocketcosts are likely to be less if you go to a Delta DentalPPO Dentist.52013-003-DD
Delta Dental PPO Dentists agree to acceptpayment according to the PPO DentistSchedule and, in most cases, this will result ina reduction of their fees. You are responsiblefor any Copayment and Deductible plus anybalance not reimbursed under This Plan up tothe PPO Dentist Schedule fee.with the Benefits, how claim payments are madeand provisions of This Plan. Delta Dental Premier Dentists agree to acceptpayment according to the Premier DentistSchedule. You are responsible for anyDeductible and Copayment plus any balancenot reimbursed under This Plan up to the PPODentist Schedule fee. Please check theSummary of Dental Plan Benefits as theCopayment and Deductible may be higher.2.Make an appointment with your Dentist. Tellyour Dentist that you have dental benefitscoverage with Delta Dental of Kentucky PPOPlan. Your Dentist should call Delta Dental at(800) 955-2030 or go to www.deltadentalky.comwith any questions about This Plan3.After you receive your dental treatment, you orthe dental office staff will file a claim form with: The Subscriber’s full name and address; The Subscriber’s Delta Dental ID number; The name and date of birth of the personreceiving dental care. If you choose a Dentist who does notparticipate in either program, you will beresponsible for any difference between theMaximum Approved Fee and the Dentist’sSubmitted Fee, in addition to any Copaymentor Deductible.Any person who, with intent to defraud orknowing that he or she is facilitating a fraudagainst an insurer, submits an application orfiles a claim containing a false or deceptivestatement is guilty of insurance fraud.Insurance fraud significantly increases thecost of health care. If you are aware of anyfalse information submitted to Delta Dental,please call our Customer Service at1-800-955-2030.Questions and AssistanceQuestions about your coverage should go to yourHuman Resources department or to our CustomerService department by US mail, phone, or e-mail:Delta Dental Customer ServiceP.O Box 242810Louisville, KY 40224-2810(800) 955-2030customerservice@deltadentalky.com.To verify that a Dentist is a Participating Dentist inThis Plan, you can use Delta Dental’s online DentistDirectory at www.deltadentalky.com or call (800)955-2030.4.Always include your name, your Group’s name andnumber, the Subscriber’s Delta Dental ID number andyour daytime telephone number with anycorrespondence.Accessing YourBenefitsIf you (a) need the assistance of the state agency thatregulates insurance or (b) have a complaint you havebeen unable to resolve with your insurer, you maycontact the Department of Insurance by mail,telephone, or e-mail.To utilize your coverage, follow these steps:1.Please read this Certificate and the Summary ofDental Plan Benefits carefully so you are familiar62013-003-DD
Kentucky Department of InsuranceConsumer Protection DivisionP.O. Box 517Frankfort, Kentucky 40602800-595-6053http://insurance.ky.gov/3. Consistent with the symptoms, diagnosis ortreatment of the condition, disease or injury.4. Payable under the Processing Policies of DeltaDental.5. Not solely for the convenience of you or yourDentist.Claim Forms6. The most appropriate level of service that cansafely be provided to you.Most Dentists will submit your dental claims for you.A Non-participating Dentist may require you to submitthe claim yourself. You can access a claim form on ourwebsite at www.deltadentalky.com or by callingCustomer Service at 1-800-955-2030. Mail thecompleted claim forms to:7. Received after your Effective Date andcompleted before your coverage ends.We will pay the claim within (30) days from the datewe receive a properly completed claim form, asprescribed by applicable law, including all requiredinformation, to determine the amount payable underThis Plan. You agree that any person or entity havingmedical information relating to the dental benefitsclaimed, may give us that information. We mayprovide such information to other persons inaccordance with our published Notice of PrivacyPractices under HIPAA.Delta DentalP.O. Box 242810Louisville, KY 40224-2810.All claims must be filed with Delta Dental within the12 months following the date of service.5.How ClaimPayment is MadeAfter we process the claim, you and/or your Dentistwill receive an Explanation of Benefits (EOB), unlessyou have no financial responsibility. The EOB is not abill, but a statement to help you understand thecoverage you are receiving. The EOB shows:If your Dentist is a Participating Dentist, Delta Dentalwill base payment on the lesser of the SubmittedAmount or the Maximum Approved Fee for a CoveredService.Delta Dental will send payment directly to aParticipating Dentist and you will be responsible forany applicable Copayments or Deductibles and anyamounts that exceed Maximum Payment amountsunder your coverage. You will be responsible for theDentist’s Submitted Amount for any Non-CoveredService.Total amount charged by the Dentist for servicesreceived (Submitted Amount). The maximum amount that your Dentist willreceive (Maximum Approved Fee). The amount for which you are responsible(patient payment).Delta Dental will process and pay all submitted claimsin accordance with this Certificate and applicable law.We cannot deny a claim or withhold payment uponyour request.For Covered Services rendered by a Non-participatingDentist or Out-of-Country Dentist, Delta Dental willsend payment to you, and you will be responsible formaking full payment to the Dentist including anydifference between Delta Dental’s payment and theDentist’s Submitted Amount.In the event of death, any Benefits payable to aCovered Person will be paid to that person’s estate.If Delta Dental pays a claim in error we may recoverthe overage from you or, if applicable, the Dentist. Asan alternative, Delta Dental reserves the right to deductfrom any pending or future claim any amounts you orthe Dentist may owe us. Payment of any claim in errordoes not mean that similar claims will be paid in thefuture.To be eligible for coverage under This Plan, a Dentalservice must be:1. A Covered Service.2. Performed by a Dentist or, as applicable, aregistered dental hygienist or other dentalprofessional as permitted by state law.72013-003-DD
Radiographs6. Benefit CategoriesX-rays as required for routine care or as needed todiagnose the condition of your teeth.This Plan covers only Covered Services listed in theSummary of Dental Plan Benefits. If there is anyconflict between the Certificate and the Summary ofDental Plan Benefits, the Summary of Dental PlanBenefits will control. The following is a description ofvarious Dental Services that can be selected for adental program. Please review the Exclusions andLimitations section regarding the information listedbelow. Your Benefits at the time of your treatmentdepend on several factors. These include yourcontinued eligibility for benefits; your availableannual or lifetime Maximum Payment; anycoordination of benefits; the status of yourcoverage; your Dentist, This Plan’s limitations,and any other provisions.Emergency Palliative TreatmentsEmergency treatment to temporarily relieve pain.Basic ServicesOral Surgery ServicesExtractions and dental surgery, including pre-operativeand post-operative care.Endodontic ServicesDiagnostic and PreventiveServicesThe treatment of teeth with diseased or damaged nerves(for example, root canals).Periodontic ServicesThe treatment of diseases of the gums and supportingstructures of the teeth, including periodontalmaintenance following periodontal therapy (periodontalcleanings).Relines and RepairsRelines and repairs to partial dentures and completedentures, and repairs to bridges.Restorative ServicesServices to rebuild and repair natural tooth structuredamaged by disease, decay, fracture, or injury.Restorative services include:Diagnostic and Preventive ServicesServices and procedures to evaluate existing conditionsand/or to prevent dental abnormalities or disease. Theseservices include examinations, evaluations, prophylaxes(routine cleanings), space maintainers, and topicalfluoride treatments. Minor restorative services, such as amalgam(silver) fillings and composite resin (white)fillings on anterior teeth. Major restorative services, such as crowns,when teeth cannot be restored with anotherfilling material.Brush BiopsyOral brush biopsy procedure and laboratory analysisused to detect oral cancer. Using this diagnosticprocedure, Dentists can identify and treat abnormal cellsthat could become cancerous, or they can detect thedisease in its earliest and most treatable stage.82013-003-DD
association, labor union, trustee, or similarperson or group.]Major Services4. Cosmetic surgery, bleaching or dentistry foraesthetic reasons, as determined by DeltaDental.Prosthodontic Services5. A complete occlusal adjustment.Services and appliances that replace missing naturalteeth (such as bridges, endosteal implants, partialdentures, and complete dentures).6. Services rendered before the Effective Date orafter the termination date of This Plan.Orthodontic Services7. Charges for hospitalization, laboratory tests,and histopathological examinations.Services, treatment and procedures to correctmalposed teeth (such as braces).8. Charges for failure to keep a scheduled visitwith the Dentist.Other Benefits9. Services as determined by Delta Dental, forwhich no valid dental need can bedemonstrated or which are specializedtechniques.Any additional Benefits specified in The Summary ofDental Plan Benefits.10. Services as determined by Delta Dental thatare Investigational in nature, includingservices or supplies required to treatcomplications from Investigationalprocedures.7. Exclusions andLimitations11. Services, as determined by Delta Dental,which are not rendered in accordance withgenerally accepted standards of dentalpractice.Exclusions12. Treatment by anyone other than a Dentist,except for services performed by a licenseddental hygienist or other dental professional asdetermined by Delta Dental under the scope ofthe professional’s license as permitted byapplicable state law.Delta Dental will make no payment for thefollowing services, unless otherwise specifiedin the Summary of Dental Plan Benefits. Allcharges for the same will be yourresponsibility.1. General anesthesia as relating to Periodontic,Prosthetic, Restorative, Endodontic orOrthodontic services or for the sole purpose ofpatient management.13. Services for which no charge is made, forwhich the patient is not legally obligated topay, or for which no charge would be made inthe absence of Delta Dental coverage.2. Services for injuries or conditions payableunder Workers’ Compensation or employer’sliability laws. Services that are received fromany government agency, political subdivision,community agency, foundation, or similarentity. NOTE: This provision does not applyto any programs provided under Title XIX ofthe Social Security Act (Medicaid).14. Replacement, repair or adjustments to spacemaintainers.15. Services received as a result of dental disease,defect, or injury for any military-connecteddisability or condition or due to an act of war,declared or undeclared.16. Services required while incarcerated in a penalinstitution or while in custody of lawenforcement authorities, including workrelease programs.3. [Dental Services received from a dental ormedical department maintained by or onbehalf of the Group, a mutual benefit92013-003-DD
17. Services for injuries sustained fromparticipating in a civil disturbance or whilecommitting an assault or felony.and are not covered under the terms of thisCertificate.Delta Dental will make no payment for thefollowing services. Participating Dentists maynot charge you or your Eligible Dependents forthese services. All charges from Nonparticipating Dentists for the following will beyour responsibility:18. Services that are covered under another groupmedical or dental plan. We will coordinatecoverage where permissible under applicablelaws.19. Services that are not within the categories ofBenefits that have been selected by youremployer or organization and that are notcovered under the terms of this Certificate.1.The completion of forms or submission of claims.2.Consultations, when performed in conjunction withexaminations/evaluations.3.Local anesthesia.21. Preventive control programs (including oralhygiene instruction, caries susceptibility tests,dietary control, tobacco counseling, home caremedications, etc.).4.Acid etching, cement bases, cavity liners, andbases or temporary fillings.5.Infection control.22. Appliances, surgical procedures, andrestorations for increasing vertical dimension;for altering, restoring, or maintainingocclusion; for replacing tooth structure lossresulting from attrition, abrasion, abfraction,or erosion; or for periodontal splinting.6.Temporary crowns.7.Gingivectomy as an aid to the placement of arestoration.8.The correction of occlusion, when performedwith prosthetics and restorations involvingocclusal surfaces.9.Diagnostic casts, when performed in conjunctionwith restorative or prosthodontic procedures.20. Fluoride rinses, self-applied fluorides, ordesensitizing medicaments.23. Temporary root canal fillings on permanentteeth.24. Chemical curettage.10. Palliative treatment, when any other service isprovided on the same date except X-rays and testsnecessary to diagnose the emergency condition.25. Personalization/characterization of anyservice or appliance.26. Separate claims for tooth preparation,temporary services, bases, impressions, localanesthesia or other services that arecomponents of a complete procedure will besubject to the Maximum Approved Fee.11. Post-operative X-rays, when done following anycompleted service or procedure.12. Periodontal charting.13. Pins and/or preformed posts, when done withcore buildups for crowns, onlays, or inlays.27. Appliances, restorations, or services for thediagnosis or treatment of disturbances of thetemporomandibular joint (TMJ).14. A pulp cap, when done with a sedative filling orany other restoration. A sedative or temporaryfilling, when done with pulpal debridement forthe relief of acute pain prior to conventional rootcanal therapy or another endodontic procedure.The opening and drainage of a tooth or palliativetreatment, when done by the same
Delta Dental of Kentucky, Inc., a Kentucky not-for-profit dental service corporation that provides dental benefits to its Subscribers. Delta Dental Plan your Copayment and Deductible, if any, as A Delta Dental company that is a member of the Delta Dental Plans Association, the nation’s largest, most ex
Delta Dental PPOSM plus Premier With the Delta Dental PPO plus Premier plan, you and your family members may visit any licensed dentist. You will receive the greatest out-of-pocket savings if you see a Delta Dental PPO provider. PP0 and Premier providers file claims directly with Delta Dental and accept Delta Dental's reimbursement in full.
Delta Dental Individual and Family - PPO Value for Seniors: Visit www.deltadentalma.com and on the Find a Dentist screen, click the box for Delta Dental PPO, or call customer service at 1-800-872-0500 Delta Dental Individual and Family - PPO Value for Seniors Plan Questions and Answers Q. What is Delta Dental Individual and Family - PPO Value
Delta Dental PPO Dentists are part of a more limited network of Participating Dentists who offer lower fees to their Delta Dental PPO patients. Delta Dental PPO Dentists are reimbursed by Delta Dental based on the lesser of the submitted charge or Delta Dental's allowance for PPO Dentists in the geographic area in which the services were .
DELTA DENTAL. Delta Dental of North Carolina . SM . DELTA DENTAL PPO PARTICIPATION APPLICATION AND AGREEMENT Delta Dental Provider Records, PO Box 30416, Lansing, MI 48909-7916 Phone (800) 656-6495 . I hereby apply to Delta Dental of North Carolina (a non-profit dental service corporation, hereinafter referred to as DDNC) to become a
For information about Network Dentists in your area, contact Delta Dental at 1.800.932.0783 and request a provider list or visit Delta Dental's web site at deltadentalins.com. When you use Delta Dental Dentists Delta Dental PPO Dentists are paid a percentage of the Delta Dental PPO Maximum Plan Allowance by
Your dental program is administered by Delta Dental Plan of Michigan, Inc., a nonprofit dental care corporation doing business as Delta Dental of Michigan . Delta Dental of Michigan is the state's dental benefits specialist. Good oral health is a vital part of good general health, and your Delta Dental program is designed to promote regular .
pharmacy directory or visit us at www.emblemhealth. com. Our customer service number is listed at the end of this introduction. Does my Plan Cover medicare Part b or Part D Drugs? PPO II, PPO III and PPO High Option do cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs. PPO I does cover Medicare Part B
Araling Panlipunan Ikalawang Markahan - Modyul 5: Interaksiyon ng Demand at Supply Z est for P rogress Z eal of P artnership 9 Name of Learner: _ Grade & Section: _ Name of School: _ Alamin Ang pinakatiyak na layunin ng modyul na ito ay matutuhan mo bilang mag-aaral ang mahahalagang ideya o konsepto tungkol sa interaksiyon ng demand at supply. Mula sa mga inihandang gawain at .
