1 Delta Dental of Oklahoma Dental Program Options for Individuals & Families
2 Solutions for You & Your Family Option 1 Delta Dental Patient Direct 2 Option 2 Delta Dental PPO Choice Advantage 3 Option 3 Delta Dental PPO Point of Service 4 Frequently Asked Questions 5
3 Delta Dental of Oklahoma Program Options for Individuals & Families 1 Delta Dental of Oklahoma Individual and Family Dental Programs At Delta Dental of Oklahoma, we believe that all Oklahomans deserve access to great dental care. So, whether you are self-employed, a student, or simply want a dental program that is not tied to your place of employment, Delta Dental has the perfect solution for you and your family. Only a well-established leader like Delta Dental of Oklahoma could make individual and family dental coverage so easy and affordable. Review your options in the following pages; if you need help making a decision, please call our Customer Service Department at or at (OKC Metro), or consult with a licensed insurance agent in your area. The Delta Dental Difference Most Experienced Delta Dental is the oldest, largest, and most experienced leading provider of dental benefits in the state and the nation. Since our beginning in 1954, dental benefits have always been our primary focus. Excellent, Local Customer Service Delta Dental of Oklahoma boasts a friendly and knowledgeable Customer Service Department located entirely in Oklahoma. Added Benefits Regardless of the program selected, you re entitled to the following benefits at no additional charge:» Discounts on vision services and materials through EyeMed Vision Care» Access to a members-only website for answers to dental questions and treatment options» Sign up for Spotlight, our online resource designed to help you get the most from your dental program Largest Dental Networks Delta Dental maintains the largest dental networks in the state and the nation. More than 90% of all licensed dentists in Oklahoma, and nearly two-thirds nationwide, participate. Not-for-Profit Nearly 90% of all premium dollars go to our dentists for the delivery of care. Remaining proceeds go towards our Foundation for education programs, scholarships and helping those unable to afford benefits receive treatment. Choice Delta Dental of Oklahoma is committed to offering a wide variety of dental care solutions for individuals and families across the state. Choose from our discount dental referral program Patient Direct, or from one of our fully-insured dental options. With Delta Dental, the choice is yours!
4 2 Delta Dental of Oklahoma Program Options for Individuals & Families Option 1 Delta Dental Patient Direct Discount Referral Program Delta Dental Patient Direct is a discount referral dental program for individuals and families in Oklahoma who do not receive dental benefits through an employer. It s affordable, valuable, and easy to use! Unlike other discount referral programs, Patient Direct features a sizeable and growing network of participating dentists. Once you enroll and pay the annual fee, you will receive a Patient Direct membership card. This card is your ticket to substantial savings on dental care. It s so easy to use sign up today!» No claim forms» No annual maximums or deductibles» No waiting periods for services» Discounts on a majority of dental services» Your program is typically effective within 1 to 4 business days» All Oklahoma residents are accepted regardless of dental history or pre-existing conditions» Pay by bank draft, Visa, or Mastercard» Complimentary vision care discounts through EyeMed Vision Care Real savings you can see when visiting a Patient Direct participating dentist! Procedure Typical Cost Your Cost Savings* Periodic Evaluation $40.00 $26.00 $14.00 Comprehensive Evaluation $63.00 $41.00 $22.00 Full Mouth X-ray $ $80.00 $43.00 Crown $ $ $ Complete Upper Denture $1, $ $ * For example purposes only. A full list of discounts will be made available after you enroll. Patient Direct Annual Rates To enroll: Please see enclosed enrollment form for current rates. Visit or Call Toll Free Important Note: Patient Direct is a discount referral program. This product is not dental insurance.
5 Option 2 Delta Dental PPO Choice Advantage for individuals and families Delta Dental of Oklahoma Program Options for Individuals & Families 3 With Delta Dental PPO Choice Advantage, you will save on the majority of dental services and procedures including routine cleanings, fillings, crowns, x-rays, and much more even orthodontics for dependent children up to age 19. This program uses a Description of Covered Services and Enrolle Co-payments table that shows you the exact co-payments and deductibles for which you are responsible when using a Delta Dental PPO participating dentist. Examples of Savings Delta Dental PPO Choice Advantage covers 5 levels of benefits ranging from preventive to major services. The table below illustrates your potential savings on some common dental treatments. Real savings you can see when visiting a Delta Dental PPO participating dentist! Example of Treatment/Cost 1 Your Cost Your Savings Percentage Savings D1110 Adult Cleaning/$70 $0 $70 100% D2330 One Surface Filling (Composite)/$126 $24 $102 81% D2750 * Crown (Porcelain Fused to High Noble Metal)/$862 $391 $471 55% 1 Based upon average submitted fees to DDOK. For example purposes only. * Must meet the waiting period requirements and applicable deductible(s). Examples of Covered Services & Co-payments Level of Service Level 1 Level 1 Level 1 Level 2 Level 2 Level 4 Procedure Code Description Subscriber Co-payment D0120 D1110 D1120 D2150 D7111 D2750 Periodic oral evaluation established patient Prophylaxis (cleaning) adult Prophylaxis (cleaning) child Amalgam (filling) two surface, primary or permanent Extraction coronal remnants deciduous tooth Crown porcelain fused to high noble metal $0 $0 $0 $26 $18 $391 These services are provided as examples of the types of services and co-payments under the Delta Dental PPO Choice Advantage option. For a complete list, see Description of Covered Services and Enrollee Co-payments table online at Deductibles and Annual Maximums Deductibles: A $50 deductible applies per member per year for Levels 2, 3, & 4 combined. Maximum Payment: $1,500 for Levels 1, 2, 3, & 4 combined. Orthodontic Services: $1,500 lifetime maximum per enrolled dependent child for orthodontic services (Level 5). PPO Choice Advantage Rates Please see enclosed enrollment form for current rates. Note: An initial 12-month waiting period applies to Level 3 services, an initial 24-month waiting period applies to Level 4 services, and a 36-month waiting period applies to Level 5 services.
6 4 Delta Dental of Oklahoma Program Options for Individuals & Families Option 3 Delta Dental PPO Point of Service for individuals and families Delta Dental PPO Point of Service features the perfect combination of access and savings. Individuals choosing this option will realize the greatest benefit level and maximum savings when utilizing a dentist in the Delta Dental PPO network, but may also utilize providers from the Delta Dental Premier network. Delta Dental PPO Point of Service Benefit Examples Delta Dental PPO Network Annual Maximum $1,000 per person Lifetime Ortho Maximum $1,000 per dependent child Delta Dental Premier Network Non-Participating (out-of-network) Class I: Diagnostic & Preventive Cleanings, evaluations, X-rays, etc. 100% 80% 70% Class II: Basic Restorative Fillings, simple extractions, oral surgery, root canal therapy, etc. After a $50 deductible per person per year and an initial 6-month waiting period 80% 60% 50% Class III: Major Restorative Crowns, dentures, implants, etc. After a $200 deductible per person per year and an initial 12-month waiting period 50% 30% 20% Class IV : Orthodontic Services The necessary treatment and procedures required for the correction of malposed teeth. Available to eligible Dependent Children under age 19, after an initial waiting period of 18 months 50% 50% 30% Note: Percentages listed are the portion of the dentist s fee that Delta Dental of Oklahoma will pay toward covered services subject to the maximum allowable charge or prevailing fee, as determined by DDOK. Plan limitations and exclusions apply. Examples of Covered Services & Co-payments With Delta Dental PPO Point of Service you may see any licensed dentist; however, your out-of-pocket expenses will be lower typically when treatment is performed by a Delta Dental participating dentist. For example, payment of a covered Class II dental service is illustrated below (the illustration assumes the annual deductible has been satisfied). Delta Dental PPO Dentist Delta Dental Premier Dentist Non-Participating Dentist (Out-Of-Network) PPO Dentist Charge $100 Premier Dentist Charge $100 Dentist Charge $100 PPO Maximum Allowable $70 Premier Maximum Allowable $85 Prevailing Fee $75 Plan Pays (80% of Delta Dental PPO Maximum Allowable) $56 Plan Pays (60% of Delta Dental Premier Maximum Allowable) $51 Plan Pays (50% of the Prevailing Fee) $37.50 You Pay * $14 You Pay * $34 You Pay * $62.50 * 20% of Delta Dental PPO Allowable * 40% of the Delta Dental Premier Allowable * Balance of the dentist charge PPO Point of Service Rates Please see enclosed enrollment form for current rates.
7 Frequently Asked Questions About Our Individual Programs Frequently Asked Questions 5 Q. Can I obtain more information about Delta Dental of Oklahoma Individual and Family programs online? A. More information can be found on our website at or call our Customer Service Department at or (OKC Metro). Q. How do I know if my dentist participates in the Delta Dental PPOnetwork? A. You can ask your dentist if he or she is a Delta Dental participating dentist and which networks he or she participates in, or you can check the Dentist Directory on our website at Q. Are there any differences between the Delta Dental PPO and Delta Dental Premier networks? A. The PPO network, consisting of nearly 60% of all dentists in Oklahoma, provides deeper network discounts and savings for our subscribers. Providing greater access, the Delta Dental Premier is the largest network locally (and nationwide), consisting of nearly 94% of Oklahoma s dentists. Q. My dentist is not a Delta Dental participating dentist. Can I go to any dentist? A. Delta Dental fully-insured dental programs allow you to use any licensed dentist. However, these programs are designed to offer greater benefits and savings when a Delta Dental network dentist is utilized. Your savings will be significantly reduced if treatment is performed by an out-of-network dentist. If enrolling in Patient Direct, you must utilize a Patient Direct network dentist. Search our Patient Direct network online at Q. Are there waiting periods? A. Specific waiting periods apply to individual and family programs Options 2 & 3, and are illustrated in this brochure. If you provide proof of previous, comparable, and verifiable dental coverage and apply within 60 days from your previous policy cancellation date, we will, in most cases, credit certain waiting periods. (No waiting periods apply to the Patient Direct Program.) Q. What happens after I enroll? A. Once your application and initial payment are processed, an enrollment kit with ID cards will be mailed to you in 7 to 10 days of your approved application. Q. What are my payment options for your fully-insured programs? A. We accept electronic funds transfers (drafts) from checking or savings accounts on a monthly basis. Debit and credit card payments are not accepted at this time. Q. What are my payment options for Patient Direct? A. You may pay your annual fee for Patient Direct via a one-time bank draft, or with a Visa or Mastercard. Q. Is everyone accepted? A. All Oklahomans, 18 years of age or older, may purchase a dental program and acceptance is guaranteed regardless of dental history or pre-existing conditions. Current Delta Dental members are not eligible. These programs may not be used in conjunction with another dental plan. Q. Can I switch between plans at any time? A. No, once enrolled, you must remain in your selected program until January 1 of the next calendar year. If you enroll and drop your dental program, you will not be eligible for coverage until 24 months later. Note: The information contained in this brochure is not intended as a policy nor is it designed to serve as evidence of coverage. Some benefits are subject to limitations, such as age of patient, frequency of procedures, etc., or excluded in some instances. For specific questions, consult your policy or call our Customer Service Department at (toll-free) or (OKC Metro).
10 Delta Dental of Oklahoma PO Box Oklahoma City, OK
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