DentaSelect is raising expectations among groups of all sizes about the benefits of affordable dental coverage. Offered to employers outside of the greater Cincinnati/Northern Kentucky market, DentaSelect has been well received since its launch in early 2005.

Unlike an HMO, where a member receives dental benefits coverage by seeking services only from a contracted participating provider, the PPO product offers non-network access capability. Through a PPO product, members can obtain service from any dentist of their choice. The product benefits do not vary by dentist; however the contractual arrangements with each dentist impact the out-of-pocket costs for the member.

In a PPO environment, if the member chooses a contracted provider for services, the member receives discounts and is guaranteed no balance billing. The member also receives benefits at the highest level based on the benefit plan design selected by the employer. For each base plan, there is a difference in co-insurance for in-network and out of network utilization.

If a member chooses to seek services from a dentist outside the contracted panel, the member will be subject to UCR levels and possible balance billing. Also, the member will pay more out-of-pocket expenses based on the co-insurance levels for in network and out of network benefits. Simply, the HMO offers no out of network benefits, while the PPO offers benefits out of network at an increased cost to the member.

The member makes the decision at the point of service. It is the member’s choice to both pay more out-of-pocket and risk balance billing, or to remain within the network of contracted providers at an increased benefit level and no balance billing. Regardless, with a PPO option, there is coverage either way.

This product benefits DCPG in areas where the network is not at full capacity, or for employers not wanting to penalize employees seeking care outside the provider network panel.