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You have the flexibility to choose any dentist with Delta Dental of Illinois individual dental plans, but your out-of-pocket costs will vary. Delta Dental's individual plans reimbursement for dental procedures is based on Delta Dental PPO fees. You will save the most money by visiting a Delta Dental PPO network dentist.
Delta Dental Premier and non-network dentists can bill for charges above the allowed Delta Dental PPO amount. This means that even if a procedure is covered at 100 percent, you may have out of pocket costs if you use a Delta Dental Premier or non-network dentists because they can bill for charges above the allowed Delta Dental PPO amount. However, Delta Dental Premier dentists cannot bill for charges above the allowed Delta Dental Premier amount, which means you may save money with a Delta Dental Premier dentist compared to a non-network dentist. See below for savings examples.
|Delta Dental PPO||Delta Dental Premier||Out-of-Network|
|The Delta Dental PPO network dentist cannot bill the difference between his/her billed fee and Delta Dental's allowed fee to the enrollee, saving the enrollee $23 in Procedure 1 and $350 in Procedure 2 (the difference between the dentist's billed fee and the Delta Dental PPO allowed fee).||The Delta Dental Premier network dentist cannot bill the difference between his/her billed fee and Delta Dental's maximum allowed fee (MPA) to the enrollee, but the dentist can bill the enrollee the difference between the MPA and the PPO allowed fee.||A non-network dentist CAN balance bill the enrollee the difference between the dentist's billed fee and the PPO allowed fee.|
|Procedure 1||Procedure 2||Procedure 1||Procedure 2||Procedure 1||Procedure 2|
Delta Dental PPO Allowed Fee
(all procedures are reimbursed based on this fee)
|Delta Dental Premier maximum allowed fee||N/A||N/A||N/A||N/A||N/A||N/A|
|Percentage paid by Delta Dental of Illinois||100%||50%||100%||50%||100%||50%|
|Amount Delta Dental Pays||$57||$425||$57||$425||$57||$425|
|Amount Dentist can Balance Bill||$0||$0||$13||$145||$23||$350|
|Your Total Cost Savings||$23||$350||$10||$205||$0||$0|
* Not applicable to members who choose Delta Dental PPO-Gold with Individual Kids Preferred, Delta Dental PPO-Silver with Individual Kids Preferred or Individual Kids Preferred. Delta Dental of Illinois’ Individual Kids Preferred plan meets all the guidelines of the Affordable Care Act’s (ACA) Pediatric Dental Essential Health Benefit (EHB). The Delta Dental PPO Individual Kids Preferred plan uses an Exclusive Provider Feature. With an Exclusive Provider Feature, benefits are paid only when a member sees a Delta Dental PPO dentist. There are no benefits when a member sees a dentist outside of the Delta Dental PPO network. However, with the Gold and Silver Plan with the Individual Preferred plan, members under age 19 can use the benefits of both plans but can only receive benefits from the Individual Kids Preferred plan with Delta Dental PPO dentists.
Use Delta Dental of Illinois' Dentist Search to find an in-network dentist in your area.
You can narrow your search based on the Delta Dental network a dentist participates in. You will save the most if you use a Delta Dental PPO network dentist. You can also map network dentist locations and create a list of selected dentists, which can be printed, emailed or converted to a PDF.
Delta Dental of Illinois offers a smart way for members to find a dentist on their smart phone or tablet via the Delta Dental mobile app. Search by your current location using your device’s GPS, or search by an important address, like home or work. Your results can be filtered (gender, language spoken, accessibility) or sorted (distance, dentist name) to help you find a dentist that suits your specific needs and once you’ve selected a dentist, you can save your dentist to your contacts, call to schedule an appointment or navigate directly to the office. The Delta Dental mobile app is optimized for iOS and Android devices (smartphones and tablets) and is available for free to download in the App Store or Google Play Store
Need additional guidance?
For enrollment help or questions, please contact us at 877-824-2776, 8:30 a.m. to 5:00 p.m. central time, Monday through Friday or by email at firstname.lastname@example.org. For customer service or claims questions, please contact Delta Dental of Illinois Customer Service at 855-327-8336, 7:30 a.m. to 5 p.m. Monday through Friday, or email email@example.com.