Broker blog from Delta Dental

Tag: Delta Dental PPO

SmileWay Wellness Benefits help your clients’ employees stay healthy

More people are becoming aware of the way that health issues can manifest in the mouth and oral health issues can exacerbate other medical conditions. With serious issues like heart disease being responsible for so many deaths in the U.S., your clients may be interested in learning how good dental health can improve overall health. If your clients’ employees have medical conditions that affect their oral health, SmileWay® Wellness Benefits may be available to help meet their needs.

Who’s eligible for SmileWay Wellness Benefits?

Not everyone is eligible for SmileWay Wellness benefits. To claim these benefits, Delta Dental members must:

  • Have a Delta Dental PPO™ plan
  • Belong to a group that offers SmileWay Wellness Benefits
  • Have chosen to opt in to the program

Additionally, members must have been diagnosed with any of the following to be eligible for expanded coverage:

  • Diabetes
  • Heart disease
  • HIV/AIDS
  • Rheumatoid arthritis
  • Stroke

What are the benefits?

Those whose plans offer SmileWay Wellness Benefits are eligible for these added benefits each calendar or contract year:

  • 100% coverage for one scaling and root planning procedure per quadrant (D4341 or D4342)
  • and 100% coverage for four of the following in any combination:
    • Prophylaxis (D1110 or D1120)
    • Periodontal maintenance procedure (D4910)
    • Scaling in the presence of moderate or severe gingival inflammation (D4346)

If your clients have employees whose medical issues necessitate extra dental care, encourage them to consider adding SmileWay Wellness Benefits to their coverage. These benefits can help keep their employees both smiling and healthy!

Effective discount: Understanding a plan’s true savings

When your group clients consider a PPO dental plan, certainly one of the deciding factors is savings — during a dental visit, how much will this plan save my employees?

Traditionally, a good way to judge this has been to consider the plan’s PPO network discount, or the discount offered on dental services when visiting a dentist within the plan’s PPO network. After factoring in the fees, the greater the discount, the better the plan, right?

Not exactly. While PPO network discount is one chapter of savings, it’s not the whole story. A more accurate way to gauge a plan’s true savings is to consider the plan’s effective discount. The effective discount considers the average savings enrollees receive when visiting any dentist, either in network or out of network.

It’s here where Delta Dental offers a unique advantage: the Delta Dental PPO™ plan with the Delta Dental Premier® network.

With most PPO plans, the PPO network is absolute — you’re in or you’re out. And if you visit an out-of-network dentist, you’re responsible for the full cost of dental services provided by that dentist. The Premier network offers a secondary network that acts as a “safety net” if a PPO enrollee can’t find, or chooses not to visit, a dentist within the PPO network.

While the Premier network provides a smaller discount than the PPO network, the combined size of the two networks — more than 155,000 unique dentists as of 2020 — ensures that most people covered under a PPO plan can visit a Delta Dental dentist and save. This large network enables Delta Dental to deliver a national network utilization rate of 94%, compared to an average PPO utilization of 65% for competitor networks.

And it’s this safety net that often makes a Delta Dental PPO plan a better value than one from another company.

For example, let’s look at a theoretical example in which there are two group PPO plans with identical fees: one from Delta Dental and one from a carrier without a secondary network. In each scenario, 10 people are insured. Five visit PPO dentists and receive a discount, and five visit non-PPO dentists. The Delta Dental plan provides a 35% discount at PPO dentists. The other plan provides a 36% discount at PPO dentists.

Given the otherwise identical scenarios, it might at first seem that the plan with the higher PPO network discount offers the better value. However, in the Delta Dental plan, four people can visit a Premier dentist for a 19% discount. Because only one person visits a non–Delta Dental dentist, the group receives a total effective discount of 25%. Contrast this with the other plan. Because half receive no discount at all, the effective discount is only 18%.

It’s not surprising then that Delta Dental offers groups the best effective discount in the country, averaging 29.4% nationally in 2019, according to a July 2020 study by Dental Actuarial Analytics. This equals more than $8.2B in savings for enrollees annually when compared to dentists’ average charges for services.

So, remember when speaking with your group clients: Savings is more than PPO discounts. When you consider effective discount, you offer a complete story. One with an ending your clients should like.

New videos help explain Delta Dental’s networks and online tools

With a new series of educational videos, it’s easy to help your clients make the most of their plans. Whether your clients offer Delta Dental PPO™, DeltaCare® USA or both, you’ll find useful resources to showcase Delta Dental’s networks and online tools.

Get to know Delta Dental’s online tools

Encourage members to sign up for an online account. This video walks members through the robust online tools Delta Dental offers, including plan details, claim history, personalized cost estimates, the online dentist directory and a wealth of wellness resources.

What if your client’s plan doesn’t include the Cost Estimator? No worries. This shorter version of the same video touches on the same helpful features, minus the personalized cost estimate.

Understand the Delta Dental networks

A PPO plan offers savings, quality assurance and simplicity. This video explains the advantages of this plan and how your clients’ enrollees can find a PPO dentist online.

Want to include the Delta Dental Premier® network to offer a wider selection of dentists? This video introduces both the PPO and Premier networks and explain how to search for both in our dentist directory.

For clients that offer a DeltaCare USA plan, this video covers the basics of this prepaid plan and shows how to select a primary care dentist.

Ensure accessibility

These videos were designed with accessibility in mind. While the vibrant visuals support the narration, all key messages are conveyed in the audio, which can also be accessed through closed captioning.

Share the videos easily

To share these videos on your website or intranet, just click on the videos to navigate to YouTube. Below the video you wish to share, click on Share > Embed. Then copy and paste the code into your webpage or intranet site.

New teledentistry options: Toothpic and Virtual Consult

Two new teledentistry options have come to Delta Dental PPO™ and Delta Dental Premier® plans. Say hello to Toothpic and Delta Dental – Virtual Consult.

Utilizing these options doesn’t require any changes to the way members use or pay for their benefits. Instead, it’s a new way for members to use existing plan benefits — remotely. These new tools are an ongoing covered benefit and have no additional administrative costs or access fees for Delta Dental clients or members.1 When members use either of these tools, they can rest easy knowing that they’ll be connected with a licensed Delta Dental dentist they can trust.

Toothpic

Toothpic is a secure HIPAA-compliant app that provides a photo-based virtual dental screening from anywhere you have a smart device and an internet connection. It’s perfect for those who want a dental checkup with a Delta Dental dentist without an appointment. Toothpic lets members:

  • Get evaluations on their own schedule by submitting pictures of their mouth, teeth and gums
  • Receive a personalized in-depth report from a Delta Dental dentist within 24 hours
  • Check in for diagnoses on areas of concern and get info about their next steps 

Virtual Consult

Virtual Consult is a secure HIPAA-compliant video-based tool for having a virtual appointment with a dentist. It’s ideal for those who have urgent oral care needs, like pain or a cracked or chipped tooth, and want to speak directly with a Delta Dental dentist. With Virtual Consult, members can:

  • Schedule and have a video appointment with a Delta Dental dentist without leaving home
  • Have quick, real-time consultations on urgent issues even if they don’t have a dentist they see regularly
  • Get an e‑prescription and aftercare instructions for pain or infection

Virtual dentistry allows members to receive a diagnosis from the comfort of their own home. Whether they’re just looking for a quick check-in or have an urgent concern, these teledentistry options can help them meet their needs with all the ease telehealth offers.

1. Members who have 100% coverage for oral evaluations and who have not exceeded their frequency limitations for office visits or limited oral evaluations are eligible to use Toothpic and Virtual Consult. Using Toothpic to receive a diagnostic report or using Virtual Consult for a remote visit each count as one office visit/oral evaluation for the purpose of frequency limitations.

2021 Small Business Program: Networks made simpler

A new video is now available to help explain the Delta Dental PPO™ and Delta Dental Premier® networks. Designed especially for Small Business Program (SBP) clients, this video highlights the differences and similarities between these networks.

Two networks, one satisfying experience

This video will help SBP clients understand the following points about our networks:

  • Members with a Delta Dental PPO plan can see any licensed dentist.
  • Between the PPO and Premier networks, Delta Dental has the nation’s largest dental network1 — finding in-network dentists is easy.
  • Members with Delta Dental PPO plans will usually save the most when they visit a PPO dentist. For members who want to visit a Premier dentist, a Delta Dental PPO Plus Premier™ plan will help increase their savings.

Stay tuned for more updates on our 2021 SBP portfolio! Looking for an overview of the SBP portfolio as a whole? We’ve got you covered.

1 Delta Dental Premier is the largest dentist network nationwide based on total unique dentists, as of March 2020, according to Zelis Network360.

2021 Small Business Program changes: Overview

The end of 2020 is right around the corner, and that can mean only one thing: updates to plan portfolios for 2021! In particular, big changes are coming to the Small Business Program (SBP) portfolio.

Introducing the three-level system

The biggest update to the SBP portfolio in 2021 is the new three-level plan structure. Whether Delta Dental PPO™, Delta Dental PPO Plus Premier™ or DeltaCare® USA, all plans will now be classified Deluxe, Advantage or Core.

  • Core plans offer the baseline benefits and value that Delta Dental plans are known for.
  • Advantage plans balance the value offered by Core plans with the expanded benefits and coverage of Deluxe plans.
  • Deluxe plans offer the most coverage and the highest levels of benefits without compromise.

More, more, more

Delta Dental PPO plans are getting more of the benefits and options that brokers’ clients have been asking for. These new features include:

  • More coverage for popular benefits, like white fillings in front and back teeth
  • More dual choice and Core/Buy-Up plans for clients looking for more plan options
  • More voluntary plan choices
  • More plans for groups with 2–4 employees
  • And even more!

It’s all about value

When your clients think about Delta Dental, they think of great benefits and amazing value. The changes coming in 2021 are going to make that even clearer. These plans are going to be easier to understand, feature more of the benefits your clients will love and offer coverage for more groups no matter their size.

Stay tuned for more posts with updates on our 2021 SBP portfolio!

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