BEN COMPARES COSTS
BEFORE HAVING A
ROOT CANAL.
Ben needs a root canal, so his dentist refers him to
two endodontists – one is in the PPO network and the
other is in the Premier network. Ben also knows an outof-network (non-participating) endodontist who was
referred by a friend.
To help him choose which endodontist to visit, Ben
researches what his out-of-pocket costs will be for
each. He calls each endodontist and obtains the
following pricing.
Note that Ben is enrolled in the Core dental plan option.
Delta Dental
PPOSM Dentist
Delta Dental
Premier® Dentist
Non-Participating
Dentist
$1,000
$1,000
$1,000
Delta Dental Negotiated Fee/ *Reasonable
and Customary Rate
$700
$880
$880*
Coinsurance Amount (Basic Service)
80%
60%
60%
Delta Dental Payment
$560
$528
$528
$700 – $560 =
$140
$880 – $528 =
$352
$880 – $528 = $352
+ $120* = $472
Dentist Charge for a Basic Procedure
Patient Payment
* Patient is responsible for amounts above the reasonable and customary rate ($1,000 - $880 = $120)
WHICH OPTION WAS RIGHT FOR BEN?
Ben chooses the provider in the PPO network because his out-of-pocket cost is lowest.
See the Benefits Roadmap Special Annual Enrollment Edition on the Benefits Resource site for more details
about the dental plan options available to The Hartford employees.
This example and the others in the 2016 Annual Enrollment communications are intended solely to demonstrate how certain health plan
options or insurance coverages operate in a particular situation. The medical costs described are for illustrative purposes only and do not
represent the actual fees that may be charged by a health care provider.
15-0828 © September 2015 The Hartford Financial Services Group, Inc. All rights reserved.