Michigan Public School Employees' Re7rement System
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1 Michigan Public School Employees' Re7rement System Fall Seminars 2017 Lisa Eggert, Senior Account Manager
2 Goals for Today Provide informa6on on plan changes Provide your cost share for covered dental services Highlight the type of providers that offer you the best value Illustrate payment examples Show you how to get informa6on about your plan Demonstrate online tools Answer ques6ons 2
3 Changes effec7ve January 1, 2018 Introduc6on of a $50 per person deduc6ble Applies when services are provided by a den6st not in the Delta Dental PPO network Applies to basic and major services only
4 Your Coinsurance Diagnos7c and preven7ve services Two cleanings, exams and fluoride (to age 21) per calendar year Basic services Restora6ve services Major services Prosthodon6c services Implants Delta Dental PPO den7st Delta Dental Premier or nonpar7cipa7ng den7st 5% 10% X-rays 5% Fillings 20% All other 25% 50% 25% Deduc&ble is applied for basic services 50% Deduc&ble is applied for major services A pre-treatment es7mate submiqed to Delta Dental allows you to learn about your treatment op7ons. Some 7me limits exist. 4
5 Your Maximums and Deduc7ble Annual maximum (per calendar year) Applies to diagnos6c and preven6ve services, basic services, and major services benefits $1,100 Orthodon7c maximum (life7me maximum) Applies to orthodon6c benefits Deduc7ble Applies to basic and major services provided den6st not in the Delta Dental PPO network $1,200 $50/person Your re7rement system s dental plan has a carve out clause for Coordina7on of Benefits (COB) when the plan pays secondary. Check out the Learning Center for addi7onal printed materials. 5
6 Your Dental Plan Offers Choices Freedom to choose any den6st Delta Dental PPO SM Delta Dental Premier Nonpar6cipa6ng Plan designed to offer the maximum benefit with the lowest out-of-pocket expense when you use Delta Dental PPO den6sts You will likely pay more when you use a Delta Dental Premier or nonpar6cipa6ng den6st 6
7 Delta Dental PPO (Preferred Provider Organiza7on Program) Providers accept Delta Dental s PPO approved amount as payment in full you only pay your coinsurance No balance billing Providers are paid directly Providers abide by Delta Dental s processing policies Highest benefit level No deduc(ble 7
8 Delta Dental Premier Providers par6cipate with Delta Dental, but do not accept the lower Delta Dental PPO approved amount you pay your coinsurance plus any addi6onal amounts for not using a Delta Dental PPO network provider Allowed to charge the difference between Delta Dental PPO approved and Delta Dental Premier approved amounts No balance billing between the Delta Dental Premier approved amount and the submi_ed amount Providers are paid directly Providers abide by Delta Dental s processing policies Deduc(ble applies to basic and major services 8
9 Nonpar7cipa7ng Providers do not par6cipate with Delta Dental and will likely cost you the most money you pay your coinsurance plus any addi6onal costs up to the provider s charge Balance billing Deduc(ble applies to basic and major services You may have to submit claims 9
10 Provider Comparison Delta Dental Delta Dental PPO SM 269,800+ loca7ons 104,467+ unique den7sts Delta Dental Premier 340,500+ loca7ons 152,626+ unique den7sts Nonpar7cipa7ng You only pay your coinsurance No balance billing Acceptance of processing policies No deduc(ble You pay your coinsurance plus any addi6onal amounts for not using a Delta Dental PPO provider No balance billing between the Delta Dental Premier approved amount and the submi_ed amount Acceptance of processing policies Deduc(ble applies to basic and major services You pay your coinsurance plus any addi6onal amounts up to the provider s charge Balance billing Deduc(ble applies to basic and major services Source: Delta Dental Plans Associa6on, April
11 Major Services (crown) Payment Example (With Deduc7ble) Provider type Charge Approved amount Deduc7ble Member cost share Coinsurance (Percent of Delta Dental PPO approved) Addi7onal cost You pay Delta Dental PPO den7st $950 $675 $0 + $ (25% of $675) + $0 $ Delta Dental Premier den6st $950 $898 $50 + $ (25% of $625*) + $223** $ Nonpar6cipa6ng den6st $950 $950 $50 + $ (25% of $625*) + $275*** $ * Delta Dental PPO approved amount minus the $50 deduc6ble ** Difference between the Delta Dental PPO and Delta Dental Premier approved amount *** Difference between the Delta Dental PPO approved amount and nonpar6cipa6ng den6st charge 11
12 Diagnos7c and Preven7ve Payment Example (Without Deduc7ble) Provider type Charge Approved amount Deduc7ble Member cost share Coinsurance (Percent of Delta Dental PPO approved) Addi7onal cost You pay Delta Dental PPO den7st $90 $55 NONE + $2.75 (5% of $55) + $0 $2.75 Delta Dental Premier den6st $90 $77 NONE + $5.50 (10% of $55) + $22* $27.50 Nonpar6cipa6ng den6st $90 $90 NONE + $5.50 (10% of $55) + $35** $40.50 *Difference between the Delta Dental PPO and Delta Dental Premier approved amount **Difference between the Delta Dental PPO approved amount and nonpar6cipa6ng den6st charge 12
13 Finding a Provider 13 For more detailed instruc7on, visit the Learning Center for a demo. Choose the network
14 Finding a Provider Choose the specialty 14 For more detailed For more instruc7on, detailed visit instruc6on, the visit Learning the Learning Center for Center a demo. for a demo.
15 Consumer Toolkit Secure Online Access 24/7 Verify eligibility status Confirm address Access benefit overview View/print EOBs Print personalized ID cards Check annual maximum used to date Read oral health informa6on Sign up for electronic EOBs 15
16 Extranet Site The link to this tool is located on the Office of Re7rement Services website under dental benefits. It can also be accessed directly at: hqp:// Access specific informa6on about your re6rement system dental plan Access wri_en plan documenta6on View this presenta6on Search the den6st directory for a provider Link to the Consumer Toolkit
17 Mobile Smartphone App Verify eligibility and benefits Find a den6st View ID card Use the Toothbrush Timer Available for Apple ios or Android users. Visit the App Store (Apple) or Google Play (Android) and search for Delta Dental. Or, scan this QR code to download the app. 17
18 Visit the Learning Center Ask specific ques6ons regarding your benefits Demo the following tools: Consumer Toolkit Delta Dental Plan of Michigan website Re6rement System extranet page Mobile app Gather health informa6on flyers 18
19 Just for Fun The strongest muscle in the body is Next to the common cold, what is the most prevalent disease in the United States? What city in Michigan was the first U.S. community to fluoridate its public drinking water in 1945? How much spit does the average human produce in a life6me? How many muscles does it take to smile? To frown? If you don t floss, what percent of your tooth surfaces do you miss cleaning?
20 Health and Wellness Save that smile! Brush at least twice a day with a fluoride toothpaste Floss regularly Avoid the use of tobacco and limit alcohol to reduce your risk of oral health problems Drink fluoridated water Keep up with regular dental visits Talk to your den6st if you no6ce any changes or abnormali6es 20
21 Contac7ng Delta Dental Toll free: Advisors Available 8:30 a.m. 8:00 p.m. (EST), Monday Friday DASI (automated system) Available 24 hours a day, seven days a week Provides benefit, claims, eligibility informa6on, Delta Dental s mailing address and the names of Delta Dental PPO and Delta Dental Premier den6sts near you 21
22 Ques7ons? 09/2017
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