Open/Switch Enrollment 2015

Transcription

1 State of NM Group Benefits Plan Plan Year Jan-Dec 2015 Administered by of New Mexico Open/Switch Enrollment 2015

2 The State of NM Group Benefits Dental Plan Provider Network PPONew Mexico (In-Network New Mexico) PPO SM (In-Network outside of New Mexico) Find a Dentist Over 1,800 points of access statewide with more than 90% of specialists participating These dentists will not bill patients for any amount over Maximum Approved Fees. Over 194,000 dentist locations nationally These dentists will not bill patients for any amount over Maximum Approved Fees. REMINDER Whenever possible, use In-Network dentists. On-line dentist search deltadentalnm.com Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees. has multiple provider networks and not every dentist participates in every network. When asking a dentist if he or she participates with, make sure to specify the PPONew Mexico provider network ( PPO if outside New Mexico). Higher levels of benefits, lower out-of-pocket costs, and important member protections apply only when services are received in-network!

3 The State of NM Group Benefits Dental Plan Benefits Overview Calendar Year Deductibles $50 per enrolled person $150 aggregate per family Does not apply to Diagnostic, Preventive, or Orthodontic Services Calendar Year Maximum* $1,750 per enrolled person per Calendar Year *Separate Lifetime Maximum applies to Orthodontic Services

4 The State of NM Group Benefits Dental Plan Benefits Overview PPONew Mexico Out-of-Network Diagnostic and Preventive Services - No Deductible Covered Oral Evaluations & Cleanings (2 per Calendar Year), Radiographic images, Topical Fluoride, Emergency Treatment, Sealants, Space Maintainers, and Diagnostic Casts Pays 100% You Pay 0% pays 100% up to fee allowable; you pay any amount balance billed Basic Services - Deductible Applies Fillings, Stainless Steel Crowns, Extractions, Oral Surgery, Root Canals, Periodontics (surgical or non-surgical), and General Anesthesia Pays 80% You Pay 20% pays 55% of fee allowable; you pay 45% plus any amount balance billed Major Services - Deductible Applies Onlays, Crowns, Bridges, Partials or Complete Dentures, Specified Implant Procedures Pays 60% You Pay 40% pays 35% of fee allowable; you pay 65% plus any amount balance billed Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees.

5 State of NM Group Benefits Dental Plan Orthodontic Benefit Overview ORTHODONTIC SERVICES No deductible Children up to 18 th birthday Plan Pays 75% up to a $2000 lifetime maximum Adults age 18 and over Plan Pays 60% Up to a $1750 lifetime maximum

6 State of NM Group Benefits Dental Plan Pre-Treatment Estimate of Benefits ASK YOUR DENTIST FOR A PRE-TREATMENT ESTIMATE OF BENEFITS when more costly procedures are anticipated. An advance estimate of benefits before dental care services are received Not required, but strongly recommended No charge for this service. Patient Disclosure You re entitled to it!

7 State of NM Group Benefits Dental Plan Customer Service/Online Resources Automated voice response benefit information available all hours Experienced Customer Service Representatives Available Monday Friday 8:00 AM - 4:30 PM (MST) or Toll Free Member Information Available 24/7! View / Print Coverage Documents & Provider Directories Verify eligibility of subscriber and dependents Confirm status of deductibles and plan maximums Review how a specific claim was processed Print a personalized subscriber ID card Mobile Application Download the new mobile app, visit the App Store (Apple) or Google Play (Android) and search for We do dental. Better.