Your Guide to Healthy Smiles: Supplemental Dental Benefits

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1 If you currently have supplemental dental coverage, you will need to enroll in a new plan during the It s Your Choice enrollment period to have coverage in See page 7 for more information. Your Guide to Healthy Smiles: Supplemental Dental Benefits A supplemental dental plan is a great way to support your oral health and your overall well-being. This guide answers some common questions about supplemental dental plans and provides a few considerations when choosing a plan.

2 Why You Need Comprehensive Dental Insurance The unexpected can happen. If you need dental work you didn t plan on for example, to repair a chipped tooth or broken crown a supplemental dental plan can help reduce the amount you pay out of pocket. It can also be a wise investment when you re considering more extensive treatments or procedures like braces or dentures. Find the right supplemental plan for you Dental plans and which procedures they cover can vary. The Uniform Dental Benefit (UDB) Plan helps cover the cost of preventive care and minor restorations like fillings. Supplemental plans help cover the costs of more expensive treatments like crowns or root canals. So how do you know which plans to choose? Consider: Your oral health Your budget Your family Your dentist Is your mouth healthy, or are you overdue for a checkup or dental work? Do you have savings or a financial plan for unexpected dental work? Consider the oral health of everyone who will be covered by your plan. Do they participate in one or both Delta Dental networks?* 2 *Please note the network(s) available for your plan type (i.e. Delta Dental PPO SM Select Plan participants can ONLY see a PPO dentist).

3 How to Choose the Right Supplemental Dental Plan Thinking about dental needs by age group may help you evaluate plan choices. Age 0-18 Help your children establish good oral health habits from the start by focusing on preventive dental care early. Cleanings, exams, fluoride treatments, sealants, and braces are all common needs in this age range. Age At this age, you may be less likely to have oral health problems but will still need regular visits to the dentist for preventive care. You may have the occasional dental emergency like a cracked or chipped tooth. If you ve started a family, be sure to include the additional needs of your dependents as well. Age As you age, so do your teeth. Consider coverage options for restorative procedures such as root canals and crowns. You may want to select a plan with a higher annual maximum to help manage out-of-pockets costs. Age 60+ Chronic conditions are more likely to occur after age 60. In addition to preventive care, look for a plan that helps manage expenses related to issues like gum disease or associated medical conditions like heart disease, diabetes, and side effects from cancer therapy. Bridges, dentures, and implants may also be on your radar. Consider a plan with a higher annual maximum. Delta Dental of Wisconsin 3

4 Supplemental Dental Plan Options Supplemental dental plans are designed to help you pay for the higher cost of major and restorative procedures not covered by the UDB. There are two supplemental dental plan options to choose from: the Delta Dental PPO SM Select Plan and the Delta Dental PPO Plus Premier TM Select Plus Plan. Note the difference in network options, plan maximums, deductibles, and coverage levels. Supplemental Benefits Network Delta Dental PPO SM Select Plan Delta Dental PPO only Delta Dental PPO Plus Premier TM Select Plus Plan Delta Dental PPO and Delta Dental Premier Individual Annual Maximum $1,000 $2,500 Deductible $100 $25 Dependent Eligibility Dependents are eligible through the end of the month in which they attain age 26. Age and frequency limitations may apply to certain benefits. Please refer to your Summary of Benefits for more information. Major & Restorative Services Implants, crowns, bridges, dentures, partials Oral surgery, extractions (surgical), endodontics, periodontics Orthodontic Services Coverage copayment Individual lifetime maximum Dependents eligible to age Adult ortho 50% 50% 0% $0 N/A No 60% 80% 50% $1,500* (in addition to UDB) 26 Yes *$3,000 total when combined with UDB. Monthly Premium Delta Dental PPO SM Select Plan Delta Dental PPO Plus Premier TM Select Plus Plan Active Employee Retiree Active Employee Retiree Self $8.55 $14.25 $16.19 $25.83 Self + Spouse $17.10 $28.50 $32.38 $51.66 Self + Child(ren) $11.54 $19.24 $29.95 $47.79 Family $20.52 $34.20 $49.38 $

5 Choose Your Dentist The UDB Plan and supplemental dental plans can help you and your family save money every time you see the dentist, whether for preventive checkups and cleanings, or unexpected expenses like fillings or crowns. You can also save more money depending on which dentist you choose. Delta Dental offers two dental networks: Delta Dental PPO and Delta Dental Premier. Both can save you money. Dentists who belong to the Delta Dental PPO network offer the greatest discounts. Dentists who belong to the Delta Dental Premier network also agree to discounts just not as deep. But the network is much broader; more than 90 percent of Wisconsin dentists belong to the Delta Dental Premier network. If you choose the Delta Dental PPO SM Select Plan, you can only see a Delta Dental PPO dentist. If you choose the Delta Dental PPO Plus Premier TM Select Plus Plan, you can see a dentist from either the Delta Dental PPO or Delta Dental Premier networks. Delta Dental offers two dental networks. Both save you money. Delta Dental PPO Dentists (In-Network dentists accepting reduced fees saving you the most money) Delta Dental Premier Dentists (In-Network dentists accepting reduced fees, but not as low as PPO dentists) Out-of-Network (No coverage) Treatment guarantees Dentists agree to repair or replace dental restorations should they fail within 24 months. No balance-billing Dentists agree to a maximum fee if their normal charge is higher than the maximum fee, they can t pass the balance on to you. Claims processing Dentists file claims on your behalf. Payments go directly to the dentist. No work for you! Delta Dental of Wisconsin 5

6 How the UDB & Supplemental Plans Work Together See how a supplemental plan works together with the UDB to help cover the cost of more extensive (and expensive) treatment. Full Crown Root Canal (molar) Braces (child) Cost without Insurance* $1,381 $1,285 $6,496 Cost when seeing a network** dentist $859 $1,158 $5,623 Uniform Dental Benefit (UDB) Pays UDB None None $1,500 Supplemental Plan Pays See the difference! Delta Dental PPO SM Select Plan Procedure cost after insurance 50% 50% None $ ,2 $579 1,2 (Includes $4,123 UDB Benefit) Delta Dental PPO Plus Premier TM Select Plus Plan 60% 80% Additional $1,500*** Procedure cost after insurance $ ,2 $ ,2 (Includes $2,623 1 UDB Benefit) 6 *Costs represent average dental fees charged within zip code To estimate costs for additional zip codes, visit Fees can vary by location, dentist, and date of service. **Delta Dental PPO or Delta Dental Premier average cost. ***$3,000 total when combined with UDB. 1 Assumes annual deductible has been met 2 Subject to annual maximum

7 LEARN HOW TO ENROLL: state-of-wi/2019-enrollment So What Does This All Mean? The UDB Plan covers some services (like cleanings, X-rays, and fillings) but there is no coverage for other restorative services like crowns, root canals, implants, or dentures. If you already see a Delta Dental PPO dentist, the Select Plan may be for you. With 50% coinsurance and a $1,000 individual annual maximum, it can save you $500 - $1,000 on future dental costs. If you think you need more coverage, the Select Plus Plan can save you the most money on restorative care and orthodontia up to as much as $4,000, depending on your dental needs. Want to sign up for supplemental? Supplemental benefits WILL REQUIRE ENROLLMENT (even if you were enrolled the previous year). There are two plans to choose from: Delta Dental PPO SM Select Plan and Delta Dental PPO Plus Premier TM Select Plus Plan. You will receive a new ID card if you choose to enroll in either supplemental plan. Visit to learn how to enroll in a supplemental plan. Questions? If you have questions during It s Your Choice open enrollment, or any time, feel free to call Delta Dental at or visit to chat with a Benefit Advisor. Delta Dental of Wisconsin 7

8 If you have any questions, please contact a Benefit Advisor or visit our website Delta Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available in different formats. Please contact Delta Dental via phone or if you would like to request information in an alternate format. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau M920D-1808

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