2017 FAQs. Dental Plan. Frequently Asked Questions from employees

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1 2017 FAQs Dental Plan Frequently Asked Questions from employees September 2016

2 Dental plan Questions we ve heard our employees ask Here are some commonly asked questions about the Dental plan that our employees have raised. To find a particular topic, click on the subject or category below to go directly to that section of the FAQ. About the Dental Plan Delta Dental Network Dental benefits Orthodontia benefits Accessing Delta Dental Important If there is ever a conflict in the information provided in this FAQ, the plan documents and summary plan descriptions will govern. In addition, participation in the benefits program does not constitute a right to continued employment with the Company. While it is the Company s intent to continue these programs, we reserve the right to amend or terminate any plan at any time, for any reason. 2

3 Dental plan About the Dental plan Q. What are my Dental plan benefits? Dover offers two Dental plan choices through Delta Dental. If you enroll, you are automatically eligible to choose from a network of Delta Dental providers who have agreed to discounted rates. This means cost savings for you when you use a network dentist or orthodontist. Dental plan, with cost-saving provider network, is administered by Delta Dental. Q. What does the Dental plan cover? You may choose between the Dental 1000 and Dental 2000 plans. Both plans provide the same level of benefits the differences are in the deductibles, annual maximum benefit and lifetime maximum orthodontia benefit. The Dental 1000 plan provides an annual maximum of $1,000 for you and each eligible dependent you have enrolled, and the Dental 2000 plan provides a maximum annual benefit of $2,000. FEATURES DENTAL 2000 PLAN (in- and out-of-network) DENTAL 1000 PLAN (in- and out-of-network) Deductible $75 single / $150 family $25 single / $50 family Annual maximum benefit $2,000 $1,000 Preventive/diagnostic services You pay 0%, no deductible You pay 0%, no deductible Basic restorative services After deductible you pay 20% After deductible you pay 20% Major restorative services After deductible you pay 50% After deductible you pay 50% Orthodontia You pay 50%, no deductible; $1,500 lifetime maximum 2 You pay 50%, no deductible; $1,000 lifetime maximum 2 Same level of benefits two choices with different deductibles, annual maximums and lifetime maximums. Both plans cover: 100% of preventive/diagnostic services 80% of basic/restorative services, after deductible 50% of major restorative services, after deductible 50% of orthodontia services for adults and eligible children to age 26 (a per person lifetime maximum applies) For coverage details, see your Benefits Enrollment Decision Guide. Q. If I waive medical coverage through Dover, can I still enroll in the Dental plan? Yes, you can enroll in the Dental plan, even if you decide not to enroll in medical coverage through Dover. 3

4 Delta Dental Network Q. Can I go to any dentist under the Dental plan? Yes, you always have a choice of who provides your dental care. However, when you choose a dentist from either of Delta Dental s two participating provider networks, it can mean more savings and no claim forms to file. Q. How do Delta Dental provider networks work? Delta Dental offers you two participating dental networks the differences between the two are the size and the cost of services: Delta Dental PPO network dentists have accepted deeper discounts on covered services, so you will likely pay less on your out-of-pocket costs and stretch your annual maximum benefit dollars. Delta Dental Premier network fees are often slightly higher than Delta Dentist PPO network dentists fees. However, you are still likely to have lower out-of-pocket costs when using a Delta Dental Premier dentist and Premier dentists won t balance bill you on the difference between the approved fees and their typical charge. To find a Delta Dental network dentist near you or to see whether your current dentist participates in the network, go to deltadentalins.com/dover for the dentist directory, or call Delta Dental at Q. Are there advantages to using Delta Dental network providers? Yes! You always have the freedom to choose any dentist, but you may want to consider why using a network dentist has advantages: You ll save money. Network dentists don t balance bill for more than their contracted fee. For example, if you are responsible for 20% coinsurance, you ll pay 20% of your dentist's contracted fee. Non-network dentists can charge you their full fee for services, so you may owe more than the deductible and coinsurance. You won t have to pay the whole bill at time of services. Delta Dental pays your dentist directly, then sends you a notice (EOB) explaining your portion of the bill. You pay the dentist only for your portion of the fee at the time of visit. You don t get charged extra. You won t be charged for services supposed to be included in the cost of treatment. For example, if you receive a crown, a network dentist won t add in extra fees for tooth preparation, local anesthesia or a temporary crown. You don t have to file claims. All paperwork will be handed by the network dentist. You ll find quality standards. Network dentists are properly licensed and meet professional standards for cleanliness and safety procedures. Q. How can I locate a Delta Dental network provider? To find a Delta Dental network dentist near you or to see whether your current dentist participates in the network, go to deltadentalins.com/dover for the dentist directory, or call Delta Dental at Helpful Tip By visiting the Delta Dental website, you ll not only be able to locate network dentists near your home or work, but also get information on office hours, what to expect at your first visit, the cost of services in your area, and more. Q. Is my dentist in the Delta Dental network? Delta Dental has an extensive network, so it s likely that your dentist is in either the Premier or PPO network. The Delta Dental dentist search tool at deltadentalins.com/dover will help you find out if your dentist is part of the network (once logged in, click Finding a Delta Dentist, then click Check if your Dentist is in Our Network. You can also contact Delta Dental customer service at Remember, you can continue to visit your dentist even if he or she is not in the network, but you ll save more money if you choose a network dentist. 4

5 Q. How does Delta Dental pay for a work in progress? For example, my root canal was started while covered by another employer s dental plan? Any dental work in progress when your Delta Dental coverage through Dover begins such as root canals, crowns and bridgework is not covered under the Delta Dental plan, and your former dental plan should assume responsibility. Delta Dental will cover treatment started and completed after the effective date of your coverage. Q. What if I use an out-of-network dentist? The Dental plan lets you visit any dentist you wish. Although you usually save money with a Delta Dentist network provider, there may be reasons why you choose to visit a non-network dentist. Keep this is mind when going out-of-network: Delta Dental does not pay out-of-network dentists directly this means, you will likely have to pay the whole bill up front at the time of service; and then submit a claim form to Delta Dental for reimbursement. Out-of-network dentists usually charge more than Delta Dental s contracted fee. You are responsible for all charges above the maximum plan allowance and may have to pay extra fees for add-in services. Q. How do I file a claim if I go to an out-of-network dentist? No claim forms are required if care is received from in-network dentists. For care received from out-of-network dentists, you must file a claim with Delta Dental. If you need to file a claim, go online to deltadentalins.com/dover and click Claim Form. Or you can contact Delta Dental customer service at Make sure you: Complete all information on the claim form, Attach the dentist's Statement of Treatment, including dentist's name, phone number, and description of services and dates performed, and Keep a copy for your records. Mail originals to (address is also on back of Form): Delta Dental of New York P.O. Box 2105 Mechanicsburg, PA Processing turn-around time Delta Dental usually processes claims within two weeks from date received, unless more information is needed from you or your dentist. You will receive a notice (EOB) of payment explaining what is covered. Q. Do I need a dental plan ID card to get care? You don t need an ID card to receive services. When you visit a Delta Dental network dentist, you will be asked for your Social Security number or plan ID number to verify your eligibility and benefits. If you still would like an ID card You can print an ID card, if you wish, by going online to deltadentalins.com/dover to view your information and to print the ID card. (New users must register by clicking Register Today and following the three-step process). You can also contact Delta Dental customer service at

6 Dental benefits Q. Where are coverage details about my Dental Plan choices? For more information about the dental plan and what s covered including the deductible and coinsurance, refer to your Benefits Enrollment Decision Guide, or visit the Delta Dental website deltadentalins.com/dover or call Delta Dental at Going online has its advantages You can find coverage details, locate a network dentist, get average costs for treatment in your area, and much more. During Annual Enrollment while you re considering your enrollment choices, you have access to the Delta Dental network dentist directory at deltadentalins.com/dover, click Finding a Delta Dentist, and then click Check if your Dentist is in Our Network. If you don t have Internet access, call Delta Dental at Q. Can I get estimates on the cost of a recommended treatment before it begins? Yes. Delta Dental can provide you with a free treatment estimate, called pre-determination, before treatment begins. While the plan doesn t require pre-treatment estimates, it s a good idea to request one for more complicated or expensive procedures, such as crowns, bridges or dentures. That way you can make more informed decisions about your dental care. Ask your dentist to submit a pre-treatment estimate in advance of performing the treatment. You can also ask about treatment alternatives, so you may be able to request a less expensive treatment if that s an option. You ll receive your pre-treatment estimate in your home mail about three weeks from your request. The estimate will show the total cost of treatment, your share of the cost, and how much Delta Dental will pay. Note Pre-treatment estimates don t take into account whether you ve met your deductible, so keep that in mind (if it s already been satisfied) when reviewing your share of the cost. Remember, too, that pre-treatment estimates are not a guarantee of benefits; the actual benefits payable will be determined by Delta Dental once services are completed. Q. What if I am covered (or my family is) by more than one dental plan? If you have coverage, and your spouse also has coverage with another dental plan, you or your family members may be covered by both dental plans. It s called dual coverage and here s how it works: The two plans will likely coordinate benefits and may save you money by lowering your out-of-pocket costs. One of the dental plans will be considered primary and pays first this is the plan covering the person directly as an employee, not as a dependent; the other plan is secondary. If your child is covered under yours and your spouse s plan, the parent whose birthday comes first (month and day) in the year is the primary plan for the child; this is called the birthday rule (a divorce decree may specify differently). Dover s Dental plan has what s called non-duplication of benefits; this means that if it s the secondary plan, Dover will not pay any benefits if the primary plan pays the same amount or more. For example, if both plans allow two cleanings a year at 80%, you are not entitled to four cleanings a year. The primary plan pays benefits as if there is no other insurance (you would be eligible for two cleanings a year). Since the secondary plan pays the same benefit (two cleanings a year), you would receive no additional benefits. In another example, if the primary plan pays 80% and the secondary plan normally covers 80% as well, the secondary plan would not pay anything more. However, if the primary plan had paid only 50%, the secondary plan would pay up to the remaining 30%. 6

7 Q. What happens if my covered child is out-of-state and away at school, or I visit an out-of-state dentist? Dental benefits are not specific to state borders, and the Delta Dental network is national. You can find dentists by location at deltadentalins.com/dover, go to Finding a Delta Dentist, and then click Check if your Dentist is in Our Network. If you don t have Internet access, call Delta Dental at Q. What happens if I reach my annual benefit maximum in the Dental Plan, will my preventative/diagnostic service continue to be covered? An annual maximum is the maximum dollar amount a dental plan will pay toward the cost of your dental care within a calendar year and includes all services combined preventive/diagnostic, basic/restorative and major services. Once you reach the annual maximum, you would have to wait until the next year for your services to be reimbursed under the plan. Q. How often is scaling and root planing covered under the Dental Plan? Once a patient is diagnosed with gum (periodontal) disease, scaling and root planing (per quadrant) is covered once every 24 months. Q. I have a medical condition that inhibits blood clotting. Would a tooth extraction be covered through the dental plan or medical plan? When you visit your dentist, be sure to share your medical history and any prior complications that may be critical to your dental care. Your dentist will then determine whether he or she can provide the service safely, and whether the extraction should be performed by a medical doctor. The coverage and plan would depend on the recommended provider and treatment. Q. Can I receive emergency dental care when out of the country? Delta Dental offers coverage for emergency dental care when outside of the U.S. If you, or an eligible family member, experience a dental emergency, immediately seek care through a licensed dentist. You will likely have to pay for services upfront. Always ask the provider for a detailed billing statement (translated into English, if possible) that includes the treatment, service date(s), and cost. The statement and completed claim form should be mailed to Delta Dental. Q. How does the Delta plan cover alternative treatments? In cases where alternative methods of treatment exist, benefits are provided for the least costly, professionally accepted treatment that restores the oral condition. Examples of optional treatments include gold fillings, overlays, bridge attachments, shoulders on crowns and other treatments not generally performed. You should always discuss the course of treatment with your dentist beforehand. If you decide to go ahead with the care, you will be responsible for the difference between Delta Dental s allowance and the approved amount for the actual treatment. Q. What if I switch to the Dental 2000 plan from the Dental 1000 plan, will the higher annual maximum ($2,000) be available? If you switch to the Dover Dental 2000 plan during annual enrollment, the higher annual maximum ($2,000) will take effect on January 1 for services incurred during the 2017 plan year. 7

8 Orthodontia benefits Q. If I am enrolled in the Dental 1000 plan and have used $1,000 of my $1,500 lifetime orthodontia maximum, and then enroll in the Dental 2000 plan in 2017, will I have an orthodontia lifetime maximum of $2,000? No, you will only be eligible for $500 since you have accumulated $1,000 towards your lifetime orthodontia maximum while enrolled in the Dental 1000 plan. Q. Who is eligible for orthodontia coverage? You and your enrolled family members are eligible for orthodontic services. Coverage for your adult children ends at age 26. Q. Do I have to see a network orthodontist to receive my benefits? No. You can visit any orthodontist, but your out-of-pocket costs may be lower if you use a Delta Dental network orthodontist. Q. Are Invisalign braces covered by my Dental plan? The maximum benefit for Invisalign is the same amount as the maximum benefit for traditional braces. If the cost of Invisalign exceeds the maximum benefit for traditional braces, you will pay the remaining cost. If you are interested in Invisalign braces, it is recommended that you ask your orthodontist to submit a pre-treatment estimate before treatment begins. If you visit an out-of-network orthodontist, you may need to submit the pre-treatment form directly to Delta Dental. Q. Do I need to submit a claim for orthodontic services? When you visit a Delta Dental network orthodontist, the dentist will submit the claim for you when the braces are first placed or the appliance is delivered. If you go to an out-of-network orthodontist, you may need to submit the claim form, available on Delta Dental website at deltadentalins.com/dover, directly to Delta Dental for reimbursement of treatment costs. Q. When will payments for orthodontic treatments be made? Payments are made in installments beginning on the initial placement or banding date and continuing either until the schedule treatment has been completed, the patient is no longer eligible for coverage or the treatment is discontinued. Installments typically do not extend beyond 24 months. Q. Will Delta Dental pay for orthodontic work that is in progress even if I began treatment under a different dental plan? Typically, orthodontic treatment in progress (braces placed) is covered. Delta Dental begins its determination of remaining balances (if any) on the first eligible month. The amount calculated to be Delta Dental s portion will be paid (in installments or lump sum) subject to 50% coinsurance and lifetime maximum benefits for orthodontic services. If you began treatment under another dental plan, or have been paying for orthodontic services out-ofyour pocket (say from your Health Care Flexible Spending Account), you will first need to submit to Delta Dental a copy of the Orthodontia Treatment Plan to determine their portion (if any). If you have questions, contact Delta Dental customer services at

9 Accessing Delta Dental Q. How can I learn more about Delta Dental? You have convenient access to the Delta Dental website from any smartphone or computer with Internet access. Dental plan Delta Dental, supplier partner Go online to deltadentalins.com/dover (new users register by clicking Register Today ) or Call ; customer service representatives are available M F, 7 a.m. to 7 p.m. CT Going online has its advantages. To access some services, you will need to log in by entering your username and password. Once you log in, you can: Look up eligibility information for you and your family members; View or print your ID card; Manage your claims preference paper or paperless; Find details about your coverage and benefits; View status of your claims in progress; Review claims already paid; Obtain average dental fees in your area; Sign up for Dental Wire, Delta Dental s newsletter, for latest information on keeping a healthy smile. Q. Can I get assistance on the Delta Dental network in a language other than English? If you need assistance in a language other than English, Delta Dental can help with its Language Assistance Program (LAP). You can obtain written materials in Spanish, and directories that include the self-reported languages of contracted dentists and their staffs. For more information, call Delta Dental at Q. What happens if I receive unsatisfactory dental care through a Delta Dental network provider? All Delta Dental dentists are required to meet professional, quality standards. If you are dissatisfied with the care received from a network dentist, Delta Dental can review the services or arrange an exam by a consulting dentist. If the consulting dentist finds the services were unsatisfactory, Delta Dental will ensure the work is corrected by the original dentist or by another network dentist of your choosing at no additional cost. If you are ever dissatisfied with care received from a network dentist, you should always call Delta Dental at

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