UNION. Dental plan. Mail Handlers Local 323 Dental Program. Extra support

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1 2017 D ota Minn e North ak ta so UNION Dental plan 3 Extra support 7 Mail Handlers Local 323 Dental Program

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3 You lie back in the dentist s chair, mouth open wide and wonder what exactly is your dentist doing in there? The truth is, your dentist does a lot. They check for cavities, diseases and other things that tell a lot about the rest of your health. Having healthy teeth is important to your overall health and well-being. And that s why choosing a dental plan is so important. Over the years, I ve helped lots of members and my own friends and family with advice. I suggest they think of these three questions when signing up for a dental plan: 1 When it comes to cost, what are my best and worst case scenarios? Best case you have healthy checkups and only pay your premium. That s how much you pay out of your paycheck each month for your dental plan. Worst case you need extra work and exceed the annual maximum. That s the total amount that your plan will pay for the year. You ll be in charge of all other costs once you reach that limit. 2 What will I have to pay when I get care? You may have a Deductible the amount you pay before your plan pitches in. If your deductible is $50, your plan won t pay for your care until you ve paid $50. Coinsurance a portion of the cost you re in charge of paying. It s different for each plan. For example, you may be responsible for 20 percent and your plan would cover the rest. 3 Where can I go? Can you see your favorite dentist and still get the best deal? You ll generally pay the least when you get care that s in-network. Member Services Questions? Don t worry we re here to help. Give us a call at or to talk through them. WHAT ELSE SHOULD YOU KNOW? You can get great perks and discounts on things like: Exercise equipment Hearing aids Healthy eating programs Spa and wellness programs (7/16) 2016 HealthPartners 3

4 Dental Open Access plan Doesn t smiling just make you feel good? Give it a try you ll see what I mean. Smiling is proven to make you feel good, seem more approachable and improve your health. I love to help people smile bright. Members call me about their dental plan, wanting to know what s covered and how often they can go. What expenses are covered? With the HealthPartners Dental Open Access plan you get: Preventive dental services covered 100 percent Extra exams and cleanings covered 100 percent if you re pregnant or have diabetes and are at risk for gum disease What does it cost to see a dentist? Well, preventive care is covered at no cost to you. But if you need extra work, like getting a cavity filled, you may pay a deductible or coinsurance. Check your Summary of Benefits (SOB) to see what those amounts might be. And remember that your dental plan has an annual maximum. It s a bit different than your medical plan. Your dental plan maximum is the most your plan will pay for your dental care each year. You re in charge of the rest. Keep in mind that you ll pay less if you see a dentist in the Open Access network and more for an out-of-network dentist. With the largest network of dentists and clinics, you ve got lots of choices. Go to healthpartners.com/dentalopenaccess to find one. Member Services We re here to help keep your teeth healthy all year long. If you have questions about your dental plan, we can answer them. Just give us a call at or (7/16) 2016 HealthPartners 4

5 The following is an overview of your HealthPartners coverage. For exact coverage terms and conditions, consult your plan materials, or call Member Services at or Plan highlights Partial listing of covered services Annual Maximum Annual maximum Implant maximum included in annual maximum Deductible - Applies to Basic Care, Special Care & Prosthetics HealthPartners Dental Network Care from a network provider Plan pays $1,500 per calendar year Plan pays $500 per calendar year $25 per person per calendar year Preventive and Diagnostic Care - Teeth cleaning, exams, dental x-rays and fluoride treatments You pay nothing - Sealants You pay nothing Basic Care Basic Care I Fillings (amalgam and anterior composite) - - Posterior composite (white fillings) You also pay the difference between the amalgam and composite fee - Simple extractions - Non-surgical periodontics - Endodontics (root canal therapy) Basic Care II - Surgical periodontics - Complex oral surgery Special Care - Restorative crowns & onlays Prosthetics - Bridges, dentures & partial dentures - Dental implants Orthodontic Services 2017 Rates: Single $48.41 Single +1 $ Family $ Summary of Benefits Dental Plan Network Mail Handlers Local 323 Group # 0016 You pay nothing You pay nothing You pay 20% You pay 50% You pay 50% You pay 50% You pay 20% You pay 40% You pay 50% You pay 50% - Orthodontic care for dependents under age 19 You pay 50% with a Lifetime maximum benefit of $1,500 paid by the plan Emergency Care Refer to the Group Dental Member Contract for coverage of emergency dental services. Diabetes and Pregnancy: Additional periodontal services (exams, cleanings, scaling and root planing, and debridement) for our members who are diabetic and/or pregnant are covered at 100% in-network. Deductibles, annual maximums, and frequency limitations will be waived on these specific services for members referred into the program by a HealthPartners network dentist. 5

6 Extra dental care if you need it They say the eyes are the windows to the soul. At HealthPartners, we say your mouth is the window to your overall health. When you get your dental checkup, your dentist does more than check for cavities and bleeding gums. They also check for signs of cancer in your mouth and up to 120 other diseases. Your teeth and gums tell a lot about the rest of your body. Did you know that people who are diabetic or pregnant are at greater risk of gum disease? It s true. Gum disease can make it harder to manage your diabetes or to have a healthy pregnancy. That s why if you re pregnant or have diabetes and are at-risk for gum disease, you get extra dental care covered at 100 percent. How does this benefit work? There s no deductible or coinsurance. Your plan will pay even if you ve already reached your annual maximum for the year. Just see an in-network dentist. You ll also be happy to know that extra dental care can help you save money and time. If a dentist catches a disease early, it can be much easier to treat by your doctor. Isn t that something to smile about? Dentist A healthy mouth helps to keep a body healthy. We re here to support you. To learn more about your dental benef its, give Member Services a call at or Why get extra dental care if you re diabetic or pregnant? Research shows that pregnant women with gum disease are seven times more likely to have a baby that s born too early or with low birth weight. People with type 2 diabetes are more likely to have gum disease, which means you re more likely to lose teeth. Diabetics with gum disease have a harder time controlling their blood sugar. This can lead to other serious health problems (8/16) 2016 HealthPartners 6

7 Healthy choices = hefty savings I know what a difference being healthy can make in your life and how a little support and savings can be a big help. That s why I m excited to tell you about some great healthy discounts you get just for being a HealthPartners dental member. Just use your HealthPartners member ID card to save money at loads of places to help you live a little healthier. You can save money on: Orthodontics Eyewear Fitness and wellness classes Healthy eating delivery services Healthy mom and baby products Recreational equipment Spa services Swim lessons And more! Health Coach Saving money is one more way we can help you live a healthier life. Go to healthpartners.com/discounts to see all the places where you can get big savings. You can save up to 35 percent on eyewear at thousands of places and get great deals on contacts too! (7/16) 2016 HealthPartners 7

8 You know how that nagging toothache always seems to get way worse in the middle of the night? And who chips a tooth at a convenient time? One thing I love about my job as a Careline 5M service nurse is that my team helps people 24/7. Give us a call, and we'll figure out how to get you the comfort you need, even in the middle of the night. Registered Nurse CareLine isn't the only one there for you. You've got a whole team of people at HealthPartners. Call us if you have questions about your dental plan. We're here to help. IF YOU HAVE QUESTIONS ABOUT: Your coverage, claims or account balances Finding a dentist or specialist that takes your health insurance Dental plan services and discounts Whether you should see a dentist Home remedies Toothaches and other dental issues CONTACT: Member Services Monday - Friday, 7 a.m. - 7 p.m., CT Call the number on the back of your member ID card, or Espanol: Interpreters are available if you need one. hea Ith partners.com Careline 5M service nurse line 24/7, 365 days a year or (7/16) 2016 HealthPartners 8

9 Manage your pearly whites on the go Life doesn t always operate on business hours. Sometimes you have a question at 9 p.m. on a Friday or 6 a.m. before you need to leave for work. That s where your myhealthpartners account and the myhp mobile app come in. Want to check on a claim for a recent dentist visit? Need to find an emergency dentist near your house, NOW? These are just a couple of the things we help members with every day. We love directing members to their online account and mobile app, especially since it means they can get help when we re not in the office. Member Services Signing up is easy! Learn more at healthpartners.com/signupnow. Top 4 ways to use your online account and mobile app: See recent claims and how much you owe for your care. Search for dentists in your network or near your current location. Check your balances, including how much you owe before your plan starts paying (deductible) and the most you ll have to pay (annual maximum). View your HealthPartners member ID card and fax it to your dentist s office (7/16) 2016 HealthPartners 9

10 Our approach to protecting personal information HealthPartners complies with all applicable laws regarding privacy of health and other information about our members and former members. When needed, we get consent or authorization from our members (or an authorized member representative when the member is unable to give consent or authorization) for release of personal information. We give members access to their own information consistent with applicable law and standards. Our policies and practices support compliant, appropriate and effective use of information, internally and externally, and enable us to serve and improve the health of our members, our patients and the community, while being sensitive to privacy. For a copy of our Notice of Privacy Practice, visit healthpartners.com or call Member Services at or Benefit limitations After you enroll, you will receive plan materials that explain exact coverage terms and conditions. This plan does not cover all dental care expenses. In general, services not provided or directed by a licensed provider are not covered. The following is a summary of excluded or limited items: Coverage for dental exams limited to twice each calendar year Coverage for dental cleanings (prophylaxis or periodontal maintenance) limited to twice each calendar year Sealants limited to one application per tooth once every three years Coverage for professionally applied topical fluoride limited to once each calendar year, for members under age 19 Coverage for bitewing X-rays limited to once each calendar year Full mouth or panoramic X-rays limited to once every three years Oral hygiene instruction limited to once per enrollee per lifetime Coverage for space maintainers limited to replacement of prematurely lost primary teeth for dependent members under age 19 Replacement of crowns and fixed or removable prosthetic appliances limited to once every five years Certain limitations apply to repair, rebase and relining of dentures Dental services related to the replacement of any teeth missing prior to the member s effective date are covered when services are performed by a provider in the HealthPartners dental network Non-surgical and surgical periodontics limited to once every two years Provider reimbursement information for dental plans Our goal in reimbursing providers is to provide affordable care for our members while encouraging quality care through best care practices and rewarding providers for meeting the needs of our members. Several different types of reimbursement arrangements are used with providers. All are designed to achieve that goal. Some providers are paid on a fee-for-service basis, which means that the health plan pays the provider a certain set amount that corresponds to each type of service furnished by the provider. Some providers are paid on a discount basis, which means that when a provider sends us a bill, we have negotiated a reduced rate on behalf of our members. We pay a predetermined percentage of the total bill for services. Some providers are paid a salary, with a possible additional payment made based on performance criteria, such as quality of care and patient satisfaction measures. We pay some groups of providers on a capitated basis, which means that the provider group receives a set fee each month for each member enrolled in the provider group s clinic, regardless of how many or what type of services the member actually receives. Provider groups are, therefore, required to manage the budget for their entire patient panel appropriately. Occasionally our reimbursement arrangements with providers include some combination of the methods described above. For example, we may capitate a provider for certain types of care and pay that same provider on a fee-for-service basis for other types of care. In addition, although we may pay a provider such as a clinic using one type of reimbursement method, that clinic may pay its employed providers using another reimbursement method. Check with your individual provider if you wish to know the basis on which he or she is paid. THIS PLAN MAY NOT COVER ALL YOUR HEALTH CARE EXPENSES. READ YOUR PLAN MATERIALS CAREFULLY TO DETERMINE WHICH EXPENSES ARE COVERED. For details about benefits and services, call Member Services at or HealthPartners The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 10

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