PEBB Dental FAQs

How does an incentive dental plan work (Full Time PEBB Delta Dental PPO Plan)?

Under an incentive dental plan, benefits start at 80% for in-network benefits during the first plan year of coverage. Payments increase by 10% in each subsequent plan year (up to a maximum benefit of 100%) provided you have visited the PPO dentist at least once during the previous plan year. If you did not visit a PPO dentist in the previous plan year there will be a 10% reduction in payment in the new plan year. Payment will never fall below 80% for in-network benefits.

Please note, this plan includes incentive-based benefits for restorative (basic) services only.

How often are cleanings allowed?

Prophylaxis (cleaning) or periodontal maintenance is covered twice per year.

Is there a deductible on the dental plan?

Yes. There is a $50 deductible on all Delta Dental plans. The deductible is waived for preventive services.

If I move from a constant plan to an incentive plan, will the incentive level follow me based on the dental services I received?

No. If you move from a constant plan (Full Time or Part Time Premier Plan) to an incentive plan (Full Time PPO Plan) your incentive level starts at 80% for in-network benefits, regardless of their original date of hire.If I have dual Delta Dental coverage under PEBB, does the maximum benefit double, as well? For example, if two spouses both have the Full Time PPO Plan, is our total maximum of $3,500 per member per plan year in lieu of the $1,750 per member per plan year?
If you have dual Delta Dental coverage under PEBB with a plan maximum (e.g., PPO Plan with $1,750 plan-year maximum), the primary plan will pay first. The secondary plan will pick up balances on allowable expenses.

Once you have met your maximum on the primary plan ($1,750 has been paid out), then the secondary plan will pay, as if it is primary, until it has also met the $1,750 maximum (dollars paid as secondary, prior to the primary maximum being met, also apply toward the secondary $1,700 maximum).

Example:

You are at the 80% incentive level under both plans and have the full maximum benefit ($1,750) available under both plans. You have a cleaning by an in-network provider and there are no prior cleanings submitted to Delta Dental within the frequency limit. The provider's charge is $100 for the cleaning and the charge is within the maximum plan allowance. The primary plan would issue a benefit of $70 and then the secondary plan would coordinate benefits and issue a benefit of $30.

You will have used $70 of your maximum under your primary plan and $30 under the secondary plan.

If I have dual Delta Dental coverage under PEBB through Delta Dental and my dentist charges more than the Maximum Plan Allowance, will the other policy pick up the remainder of the charges through coordination of benefits?

If you have dual Delta Dental coverage under PEBB with a plan maximum (e.g., PPO Plan with $1,750 plan-year maximum), the primary plan will pay first. The secondary plan will pick up balances on allowable expenses.

When you visit a dentist who is in the Delta Dental Premier® Network or the Delta Dental PPO(SM) Network, you will not be billed for charges over the contracted fees. As a Delta Dental participating provider, the provider will write off the amount that is billed over the contract allowance.

A secondary Delta Dental plan, will pay up to the highest allowable charge between the plans, not to exceed the billed amount. If there is a charge over the allowed amount (for example, due to seeing a provider that is out of network with one or both of the plans), you would be responsible for the extra charge.