We are excited to share details about a new Delta Dental plan design called PPO MAC (Maximum Allowable Charge) plan. A MAC plan is a Delta Dental PPO (Preferred Provider Organization) plan that reimburses Preferred and Premier providers at the PPO fee schedule. A MAC plan differs from a traditional PPO plan because it allows Premier providers to balance bill the difference between their PPO fee and their filed fee. Adding this MAC plan to our dental products ensures a more competitive portfolio and offers another option for our employer groups. In addition, the premium for a MAC plan is less costly than Delta Dental of Oregon's traditional PPO plan and could offer cost savings to the member when dental services are performed by a PPO provider.
The grids below show the provider's network and fee administered for a MAC plan compared to a traditional PPO plan.
MAC plan:
|
Provider Network:
|
PPO Fee
|
Filed Fee
|
Non-Par Rate
|
Can provider balance bill?
|
|
Preferred Provider
(in-network)
|
X
|
|
|
No |
|
Premier Provider
(out-of-network)
|
X
|
|
|
Yes - The difference between PPO fee and filed fee |
|
Non-Participating Provider (out-of-
network)
|
|
|
X
|
Yes - The difference between non-par rate and billed charge |
Traditional PPO plan:
|
Provider Network:
|
PPO Fee
|
Filed Fee
|
Non-Par Rate
|
Can provider balance bill?
|
|
Preferred Provider (in-network)
|
X
|
|
|
No |
| Premier Provider (out-of-network) |
|
X
|
|
No |
| Non-Participating Provider (out-of-network) |
|
|
X
|
Yes - The difference between non-par rate and billed charge |
You will be able to identify a member with a PPO MAC plan by the Insurance Type displayed in Benefit Tracker. The Insurance Type will read - Delta Dental PPO - MAC plan (it's important to take note of the member's Insurance Type in Benefit Tracker since their member ID card will show the network as Delta Dental PPO without the MAC plan identifier).
Also, when you select Group Limitations, you will see a disclaimer under the Benefits section confirming that the member is on a MAC plan.
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