Benefits administrator blog from Delta Dental

Tag: in-network utilization

Effective discount: Understanding a plan’s true savings

When you 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 considering a dental plan for employees, savings is more than PPO discounts. When you consider effective discount, you offer a complete story. With an ending your employees should like.

May the Fourth (of our PPO network) be with you!

On this fourth day of May, we’d like to remind you of the benefits of PPO network utilization — Star Wars style. May the network force be with you (and with your enrollees)!

First, we interviewed Yoda about the benefits of offering a PPO plan. He says, “To offer your enrollees a PPO plan because they have the freedom to choose any dentist, you probably chose. And with a Delta Dental PPO™ plan, offering secondary access with our Delta Dental Premier® network, you are.”

And he’s right — with Delta Dental PPO, more of your enrollees have an opportunity for moderate savings with a Premier dentist. (But they’ll usually save the most if they go PPO, which is why it’s important for enrollees to understand how to use their plan.)

Need some Jedi wisdom on your dental benefits? Here are some answers to common questions and some things for you (and your enrollees) to consider.

Network (and non-network) dentist visits: A battle scenario

Let’s say your enrollees are young Jedis about to battle skilled Sith warriors. In this scenario, the Sith warriors are the out-of-pocket costs of going to the dentist. So, have your enrollees choose a weapon.

  • No weapon means minimal protection — kind of like visiting a non-Delta Dental dentist. Your enrollees aren’t taking advantage of any of the network savings that your carrier is offering.
  • Using a lightsaber is nice, but your enrollees wouldn’t bring a lightsaber to a blaster fight, would they? This is moderate protection — like visiting a Delta Dental Premier dentist.
  • Finally, using a blaster is usually your enrollees’ most reliable form of protection. Like visiting a Delta Dental PPO dentist, they’re getting the most protection against Siths — er, out-of-pocket costs.

“What if my group has a PPO plus Premier plan design?” We thought you might ask. In that scenario, you’re offering your enrollees more protection against balance billing than you would be with a standard PPO plan, but they (and your group’s overall plan costs) will usually benefit most from going PPO.

Dental networks and finding a dentist

A dental plan is only as valuable as its network. That’s why we’re proud to offer expansive, nationwide PPO access. If you think an army of storm troopers is a crowd, you haven’t seen our provider directory.

And your enrollees don’t have to go to Tatooine to find network savings — tell them to log in to our online services and use our Find a Dentist tool to find a PPO dentist near their home, office or any chosen location.

Encouraging PPO utilization 

You should talk with your employees about the benefits of in-network dentist visits, like more potential savings and more convenience with no claims forms.

In Yoda’s words, pass on what you have learned! Consider attaching this instructional flyer (PDF) to your next group email and encourage them to search only for PPO dentists. And remember — the force is strong with those who go PPO.


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Delta Dental PPO: Is your group part of the in-crowd?

2‑minute read

One of the best parts about choosing a PPO dental plan for your employees is giving them the freedom to choose any licensed provider for their next visit. And, with Delta Dental, you’re offering additional access with our Delta Dental Premier® network. With so many choices, it’s important to weigh the options.

Network utilization is a key aspect of your dental plan — because in-network visits could save you money or help stabilize your group’s plan costs over time. Some things to consider:

What does in-network actually mean?

If you currently offer a Delta Dental PPO™ plan, in-network visits always mean visits to PPO dentists. We’d like to say it’s that simple, but sometimes offering twice the freedom results in twice the questions.

What about Premier visits?

The Delta Dental Premier® network acts as a safety net for out-of-pocket costs, so enrollees usually save more than they would if they visited a non-Delta Dental dentist. However, the Premier network doesn’t offer the deep discounts that PPO can.

What if I offer a PPO plus Premier plan?

If your group offers a Delta Dental PPO plus Premier™ plan, or any plan in which non-PPO dentists are not reimbursed based on contracted PPO fees, enrollees will still save the most when they go PPO. The difference for these plans is how we calculate fees for claims. The plan still offers a safety net for non-PPO claims if enrollees visit a Premier dentist, and you’re offering them more balance billing protection if you choose a fee basis other than the PPO contract allowance for all claims.

How do I encourage PPO utilization?

Talk with your employees about the benefits of in-network dentist visits, like more potential savings and more convenience with no claims forms to fill out. You can also remind them to find a network dentist using our find a dentist tool. Consider attaching this instructional flyer to your next group email and encourage them to search only for PPO dentists.


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