Pflugerville ISD offers a Preferred Provider Organization (PPO) dental program through Delta Dental with a low and high option to choose from. Each plan provides benefits for various types of dental services. This benefit is available to all eligible employees and their dependents to age 26.
The difference between in-network and out-of-network
An out-of-network dentist is not contracted with certain dental insurances meaning insurance pays less or nothing at all to the dentist for services. This means you may be left with a much larger out-of-pocket portion for work done at an out-of-network dental office.
The percentages in the “Non-Delta Dental PPO dentists” column in the Summary of Benefits reflect what the insurance will pay based on the Maximum Contract Allowance not the submitted fee by the provider. What this means is that the provider can balance bill you for what Delta Dental didn’t pay.
[For example, Dr. R is an out-of-network dentist. You have a routine examination, cleaning and x-rays. He submits to the insurance a total of $256 in fees. The maximum contract allowance is $137. Delta Dental will pay 100% of this maximum contract allowance ($256 - $137 = $119) while you end up paying $119 for a service that you could have had for free (in-network).]