Brevard Public Schools

Transcription

1 Brevard Public Schools Your Delta Dental Benefits Plan

2 Delta Dental PPO High & Low Option Plan Highlights Diagnostic & Preventive Maximum Waiver Benefit Missing Teeth Covered Composite Fillings Covered Sealants for children Covered Implants covered under Major services Visit any dentist, in or out of Delta Dental s network No referral required for Specialist services

3 D & P Maximum Waiver Benefit Delta Dental D&P Maximum Waiver Costs for D&P services do not count toward your annual max benefit More dollars available for non-d&p services D&P dollars are available on your first effective date No qualifying visits or dollar amounts to satisfy No expiration of benefits No maximum rollover dollar limitations D&P Waiver renews automatically No time period requirement to meet before receiving benefits Solstice Rollover Benefit Rollover dollars are not available until 2nd year of coverage 1st year requirements such as cleanings or submitted claims apply Rollover Dollar Limitations Dollar amounts or qualifying visits must be tracked or reported

4 High Option PPO Delta Dental PPO SM1 Benefits In-Network Out-of-Network Diagnostic/Preventive Exams, Cleanings, X-Rays, Fluoride Basic Periodontics, Endodontics, Restorative, Simple Extractions, Sealants Major Prosthodontics, Crowns & Casts, Inlays & Onlays Orthodontics (Child only to age 30) Deductible (waived on D&P services)) Per patient/calendar year Per family/calendar year Maximums Per patient/calendar year Lifetime Ortho Max D&P Maximum Waiver Waiting Periods 100% 100% 80% 80% 50% 50% 50% 50% $50 $150 $1,250 $1,000 $50 $150 Diagnostic and preventive services do not count against calendar year maximum None

5 The Choice Is Yours High Option PPO savings illustrated Example High Option PPO Dentist s charge for a crown Sample plan allowance based on: Delta Dental PPO SM Dentists Delta Dental Premier Dentists Non-Contracted Dentists $900 $900 $900 $650 PPO plan allowance $750 Premier plan allowance $800 Program allowance Coinsurance amount 50% 50% 50% Plan payment $325 $375 $400 Balance billing No No Yes: $100 Member payment $325 $375 $500

6 Low Option PPO Delta Dental PPO SM1 Benefits In-Network Out-of-Network Diagnostic/Preventive Exams, Cleanings, X-Rays, Fluoride Basic Periodontics, Endodontics, Restorative, Simple Extractions, Sealants Major Prosthodontics, Crowns & Casts, Inlays & Onlays Orthodontics (Child only to age 30) Deductible (waived on D&P services)) Per patient/calendar year Per family/calendar year Maximums Per patient/calendar year Lifetime Ortho Max D&P Maximum Waiver Waiting Periods 100% 100% 70% 70% 40% 40% 40% 40% $50 $150 $750 $1,000 $50 $150 Diagnostic and preventive services do not count against calendar year maximum None

7 The Choice Is Yours Low Option PPO savings illustrated Example Low Option PPO Dentist s charge for a crown Sample plan allowance based on: Delta Dental PPO SM Dentists Delta Dental Premier Dentists Non-Contracted Dentists $900 $900 $900 $650 PPO plan allowance $650 PPO plan allowance $650 PPO allowance Coinsurance amount 50% 50% 50% Plan payment $325 $325 $325 Balance billing No Yes: $100 Yes: $250 Member payment $325 $425 $575

8 DeltaCare USA DHMO Plan Highlights No Deductible No dollar maximums No Waiting Periods for coverage Material & Lab Fees: Included in Copay (noble metal, high noble metal, titanium, porcelain inlays, onlays, crowns & bridges) All three (3) phases of Orthodontics are covered Extractions for Orthodontics covered Orthodontics Takeover for the life of the contract Teeth whitening covered Primary Care Dentist performs & coordinates all dental care

9 DeltaCare USA 15B High DHMO Plan - Sample of common procedures & copayments DeltaCare Benefits Diagnostic/Preventive Oral Exam Cleaning Basic 2 surface amalgam filling 2 surface composite filling, anterior Simple Extraction Major Crown, high noble metal Molar root canal Denture upper/lower, per Orthodontics Comprehensive Child or Adolescent ortho treatment Comprehensive Adult ortho treatment No Maximums, deductibles, additional copays or waiting periods Copayment $0 $5 $12 $26 $14 $395 $365 $365 $1,900 $2,100

10 DeltaCare USA M74 Low DHMO Plan - Sample of common procedures & copayments DeltaCare Benefits Diagnostic/Preventive Oral Exam Cleaning Basic 2 surface amalgam filling, primary or permanent 2 surface composite filling, anterior Simple Extraction Major Crown, high noble metal Molar root canal Complete Denture upper/lower, per Orthodontics Comprehensive Child or Adolescent ortho treatment Comprehensive Adult ortho treatment No Maximums, deductibles, additional copays or waiting periods Copayment $0 $0 $0 $35 $14 $485 $245 $510 $2,100 $2,250

11 Web Capabilities Easy-to-use provider directories with maps & driving directions Secure login for benefits & eligibility lookup Access information on program benefits, eligibility, status of deductibles, maximum usage, claim status & claims history Fee Finder for common procedures Printable claim forms Printable ID cards Extensive dental health section inquiries to customer service Viewable in Spanish

12 Find a Dentist Go to www. On the right side menu under Find a Dentist, type your Zip Code or City & State Then, under Select Network, use the drop down menu to select DeltaCare USA for the DHMO, Delta Dental PPO or Premier for the PPO Then, click on Search Once you click on Search, you can refine your search results by your dentist s name, practice name, etc. and click Search again to view your results.

13 Delta Dental on the go: PPO enrollees, log-in to: Check benefits, eligibility, deductibles & maximums Search for benefits by keyword or procedure code Check claims status & claims history View your ID card pull it up at your dentist s office Go paperless Choose Receive Statements Online under My Account Find a Dentist Choose between PPO & Premier Dentists

14 Customer Service Need Assistance? PPO Enrollees Call toll-free: Monday - Friday 7:15 a.m. - 8:00 p.m., Eastern Time DeltaCare USA / DHMO Enrollees Call toll-free: Monday - Friday 8:00 a.m. - 9:00 p.m., Eastern Time