DPPO — Delta Dental of Tennessee
- The network is PDP.
- You can use any Dentist, but you receive maximum benefits when visiting an in-network Delta Dental DPPO provider. Deductible applies for Basic and Major dental care.
- You pay coinsurance for Basic, Major, Orthodontic and out-of-network covered services.
- You or your Dentist will file claims for covered services.
- Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a six-month Waiting Period from the member’s coverage start date before benefits begin.
- There is a 12-month Waiting Period from the member’s coverage start date for both the replacement of a missing tooth and also Orthodontics.
- Referrals to Specialists are not required.
- Pre-treatment estimates are recommended for more expensive services.
- Dental treatment in progress at time of member’s effective date with MetLife may have pro-rated benefits under the MetLife plan.
You pay coinsurance for many covered services and your share is based on the "maximum allowable charge" (MAC) for a given service. MAC is the lesser of the amount charged by the dentist or the maximum payment amount that in-network dentists have agreed to accept in full for the dental service. When you receive dental services from an out-of-network provider, MetLife will reimburse a percentage of the MAC. You are then responsible for everything over the percentage of MAC reimbursed up to the charge submitted by the out-of-network dentist. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.