Delta Dental

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  • The DeltaCare USA program is a prepaid dental program. With this type of program you must visit your assigned general dentist to receive benefits or to obtain a referral for specialty care.
  • You will initially be assigned a network provider. If you would like to use a different network provider, please contact customer service to update your election prior to seeking services. Deductibles and maximums do not apply to the DeltaCare USA program. Each procedure has a fixed copay assigned, and it’s easy to know what your treatment costs will be ahead of time. At the time of your visit, you simply pay the copay amount – it’s that easy.
  • With the DeltaCare USA plan, you will receive most of your care from your assigned general dentist, however there may be occasions when you will need to visit a specialist. DeltaCare makes this process quick and easy for you. If you or one of your covered dependents needs specialty care, your DeltaCare dentist will submit a preauthorization request. After they receive the preauthorization from your plan administrator, they will direct you to a qualified specialist for treatment.
  • With the DeltaCare USA plan, you will receive most of your care from your assigned general dentist, however there may be occasions when you will need to visit a specialist. DeltaCare makes this process quick and easy for you. If you or one of your covered dependents needs specialty care, your DeltaCare dentist will submit a preauthorization request. After they receive the preauthorization from your plan administrator, they will direct you to a qualified specialist for treatment.
  • When you enroll in the DeltaCare USA plan, you will be assigned a dentist. If you wish to change dentists, you can obtain a list of DeltaCare USA dentists by visiting the Delta Dental web site or by calling the toll-free number for DeltaCare USA.
  • The Delta Dental PPO is a reduced fee-for-service plan. This plan covers services received from a licensed dentist anywhere in the world. Although you may visit any dentist, you will usually pay the least out-of-pocket when you visit a PPO dentist.
  • If you do not wish to visit a PPO dentist, visiting a Premier dentist is your next best option, because you can still enjoy cost protections and balance billing protection with a Premier dentist. Delta dentists also agree to file all claim forms for you, and to accept payment directly from Delta Dental. With a Delta dentist, you will never have to pay the entire cost of service up front, then file the claim and wait for reimbursement. You will only be responsible for your percentage of the coinsurance, as well as any deductibles and amounts in excess of maximums.
  • One of the advantages of Delta Dental is the added protection that our Premier dentists provide. PPO enrollees who choose not to visit a PPO dentist still retain some meaningful cost protections when visiting a Delta Dental Premier dentist. This chart provides an illustration of your out-of-pocket costs depending on the dentist you visit.
  • If you are interested in enrolling in the PPO plan, you may want to research the Delta dentists in your area. Delta Dental makes it easy to find a dentist either by visiting our web site or by calling our automated information line. Remember when you check with a dentist, ask if they are a Delta Dental PPO dentist or a Delta Dental Premier dentist . Many dentists will “accept Delta Dental Insurance” but this does not mean that they are a Delta network dentist.
  • Now that you have reviewed general information about your plan choices, you may wish to review this side by side comparison to make the choice that works best for you.
  • Hopefully, you now have a good idea which plan you would like to enroll in. The following pages contain some helpful information about the services and support you will receive when you become an enrollee in either plan.
  • DeltaCare USA provides you many ways to obtain information. These include automated voice lines, fax-back capabilities, internet tools, and of course, our friendly and helpful service representatives. You can use these tools to find a dentist, request a change in your assigned dentist, obtain an ID card, view eligibility and benefits for you and your dependents or obtain dental health information.
  • DeltaCare USA provides you many ways to obtain information. These include automated voice lines, fax-back capabilities, internet tools, and of course, our friendly and helpful service representatives. You can use these tools to find a dentist, request a change in your assigned dentist, obtain an ID card, view eligibility and benefits for you and your dependents or obtain dental health information.
  • DeltaCare USA provides you many ways to obtain information. These include automated voice lines, fax-back capabilities, internet tools, and of course, our friendly and helpful service representatives. You can use these tools to find a dentist, request a change in your assigned dentist, obtain an ID card, view eligibility and benefits for you and your dependents or obtain dental health information.
  • DeltaCare USA provides you many ways to obtain information. These include automated voice lines, fax-back capabilities, internet tools, and of course, our friendly and helpful service representatives. You can use these tools to find a dentist, request a change in your assigned dentist, obtain an ID card, view eligibility and benefits for you and your dependents or obtain dental health information.
  • Delta Dental PPO also provides you with a myriad of ways to make your dental benefits plan hassle-free by providing toll-free numbers, internet tools and personal assistance.
  • Use our Internet site to learn more about your benefits, find a dentist if you are traveling outside the U.S or print an ID card. We’ve provided a wealth of information for you, and it’s all at your fingertips.
  • Use our Internet site to learn more about your benefits, find a dentist if you are traveling outside the U.S or print an ID card. We’ve provided a wealth of information for you, and it’s all at your fingertips.
  • Thank you for taking the time to learn more about Delta Dental and your dental benefits program.
  • Delta Dental

    1. 1. Benefits Contacts In-service Dental Benefits July 29, 2008
    2. 2. YOUR DELTA DENTAL TEAM <ul><li>Keith Edwards, Sales Account Executive </li></ul><ul><li>Paulette Blinn, Account Manager </li></ul>
    3. 3. The Benefits of Choice <ul><li>Four great Delta Dental options from which to choose </li></ul><ul><li>Choose between the DeltaCare ® USA Low Plan FLM74 or High Plan FL15B </li></ul><ul><li>and the Dental PPO High or Low Plan </li></ul><ul><li>Coverage begins according to eligibility date </li></ul>
    4. 4. DeltaCare ® USA Prepaid Plan
    5. 5. DeltaCare ® USA Plan Highlights <ul><li>Patient pays pre-specified copayment for each covered procedure (no copay required for routine exams and cleanings). </li></ul><ul><li>Patient can select a dentist at enrollment. </li></ul><ul><li>Specialty care provided by specialists requires preauthorization (referral). </li></ul>
    6. 6. DeltaCare ® USA Plan Highlights <ul><li>Enrollees cannot receive benefits if care is provided by dentist who is not the selected provider. </li></ul><ul><li>No deductibles or annual maximums. </li></ul><ul><li>No (or very low) copayments for diagnostic and preventive services. </li></ul><ul><li>Fixed copayments for basic and major services on the DeltaCare ® USA High Plan. </li></ul>
    7. 7. Visiting a Specialist with DeltaCare ® USA High Plan <ul><li>General dentist determines work needs to be done beyond his/her scope of expertise. </li></ul><ul><li>Dentist submits request for pre-authorization to plan administrator. </li></ul><ul><li>Plan administrator authorizes procedure(s). </li></ul><ul><li>Dentist provides referral to DeltaCare ® USA specialist. </li></ul><ul><li>Specialty care performed by a specialist must be authorized before work is performed, and must be done by a DeltaCare-approved specialist. </li></ul>
    8. 8. Visiting a Specialist with DeltaCare ® USA Low Plan <ul><li>General dentist determines work needs to be done beyond his/her scope of expertise. </li></ul><ul><li>Dentist submits request for pre-authorization to plan administrator. </li></ul><ul><li>Plan administrator authorizes procedure(s). </li></ul><ul><li>Dentist provides referral to DeltaCare ® USA specialist. </li></ul><ul><li>Low Plan enrollees receiving specialty care are eligible for a 25% discount if services are provided by a DeltaCare ® USA specialist. </li></ul>
    9. 9. Prepaid Plan Designs Example Only $510 $365 Complete dentures 5110 $465 $335 Crown 2752 $28 $22 Filling 2330 No cost No cost Adult Cleaning 1110 No cost No cost Oral Exam 0120 Low Plan High Plan Procedure
    10. 10. How do I find a DeltaCare ® USA dentist? <ul><li>Visit www.deltadentalins.com to search by name, address, specialty. Print directories and driving directions. </li></ul><ul><li>Call (800) 422-4234. Our automated information line provides voice information or can fax a list of dentists, whichever you prefer. </li></ul><ul><li>Requests for dentist changes received by the 15 th of the month will become effective the first of the following month. </li></ul>
    11. 11. Delta Dental PPO Delta Dental Insurance Company
    12. 12. Delta Dental PPO Plan Highlights <ul><li>Freedom of choice – patient can visit any dentist. </li></ul><ul><li>Reduced fee-for-service: Maximize savings by utilizing PPO (in-network) dentists. </li></ul><ul><li>Nationwide coverage – visit any licensed dentist anywhere in the world. </li></ul><ul><li>Visiting a Delta Dental PPO (in-network) dentist usually saves patients almost 30% on average out-of-pocket costs. </li></ul>
    13. 13. Delta Dental PPO Plan Highlights <ul><li>Visiting a Delta Dental Premier (out-of-network) dentist usually saves patients almost 20% on average out-of-pocket costs. </li></ul><ul><li>Visiting a non-Delta (out-of-network) dentist may cost you more in out-of-pocket expenses – the dentist has not agreed to provide services at reduced fees. </li></ul><ul><li>Maximums and deductibles apply. </li></ul><ul><li>Reimbursement for each procedure is based on coinsurance – the enrollee pays a percentage and the insurer pays a percentage. </li></ul>
    14. 14. Delta Dental PPO High Plan Highlights Benefits And Covered Services * Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions. *Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Evidence of Coverage or Summary Plan Description for waiting periods and a list of benefit limitations and exclusions. **Fess are based on PPO fees for in-network dentists and for out-of-network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist's actual fees. $1,000 50% 50 % 80 % 100 % Yes $50 per enrollee, $150 per family, per calendar year PPO Dentist** $1,000 ORTHODONTIC MAXIMUMS 50% ORTHODONTICS * 50 % MAJOR BENEFITS -- Crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, full dentures) 80 % BASIC BENEFITS -- F illings, denture repairs, Endodontics (root canals), Periodontics (gum treatment) , Oral Surgery 100 % DIAGNOSTIC & PREVENTIVE BENEFITS -- Oral examinations, cleanings, x-rays, fluoride treatment, space maintainers The maximum benefit paid per plan year is $1,500 per person ANNUAL MAXIMUM DEDUCTIBLE WAIVED FOR DIAGNOSTIC & PREVENTIVE? DEDUCTIBLES Primary enrollee, spouse and eligible dependent children to age 25 WHO’S ELIGIBLE Non-Delta Dentist**
    15. 15. Delta Dental PPO Low Plan Highlights Benefits And Covered Services * Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions. *Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Evidence of Coverage or Summary Plan Description for waiting periods and a list of benefit limitations and exclusions. **Fess are based on PPO fees for in-network dentists and for out-of-network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist's actual fees. $1,000 40% 40 % 70 % 100 % Yes $50 per enrollee, $150 per family, per calendar year PPO Dentist** $1,000 ORTHODONTIC MAXIMUMS 40% ORTHODONTICS * 40 % MAJOR BENEFITS -- Crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, full dentures) 70 % BASIC BENEFITS -- F illings, denture repairs, Endodontics (root canals), Periodontics (gum treatment) , Oral Surgery 100 % DIAGNOSTIC & PREVENTIVE BENEFITS -- Oral examinations, cleanings, x-rays, fluoride treatment, space maintainers The maximum benefit paid per plan year is $1,000 per person ANNUAL MAXIMUM DEDUCTIBLE WAIVED FOR DIAGNOSTIC & PREVENTIVE? DEDUCTIBLES Primary enrollee, spouse and eligible dependent children to age 25 WHO’S ELIGIBLE Non-Delta Dentist**
    16. 16. <ul><li>Delta Dental offers PPO enrollees a unique feature – Premier dentists, which provides additional cost protections for our PPO plans. </li></ul><ul><li>If you can’t visit a PPO dentist, Premier dentists usually can save you money over visiting a non-Delta Dental dentist. (Low Plan) </li></ul>Unique Cost Savings: The Delta Difference ® *Patient’s share is the coinsurance/copayment, any remaining deductible, any amount over the annual maximum and any services your plan does not cover Amounts shown are for illustrative purposes only. Actual amounts may vary by provider and region. $45.00 $ 45.00 Delta Dental’s payment No patient savings $ 90.00 Patient saves $135.00 $ 45.00 Patient payment* $180.00 No fee agreement with Delta Dental $ 90.00 Delta Dental’s plan allowance $180.00 $180.00 Dentist bills Non-PPO (out-of-network) Dentist PPO (in-network) Dentist Procedure:
    17. 17. How do I find a dentist for my Dental PPO plan? <ul><li>Visit www.deltadentalins.com to search by name, address, specialty. Print directories and driving directions. </li></ul><ul><li>Call (800) 521-2651. Our automated information line provides voice information or can fax a list of dentists, whichever you prefer. </li></ul><ul><li>Ask your dentist if they are a contracting PPO dentist. </li></ul><ul><li>If you do not find a PPO dentist, your next best option is to search for a Premier dentist. </li></ul><ul><li>Visit the dentist of your choice – it’s that easy. </li></ul>
    18. 18. Choosing Between a PPO and a Prepaid Plan * As of June, 2006 Visit your assigned DeltaCare dentist to receive benefits Pay only the copayment at the time of treatment. Note: Enrollees on Basic plan have a 25 discount off the filed fees when a DeltaCare ® USA specialist is used. You usually have the lowest out-of-pocket expenses when visiting a Delta Dental PPO dentist If you don’t see a PPO dentist, a Delta Dental Premier dentist is usually your next best option Contracting Dentists More than 20,000 DeltaCare ® USA offices in the U.S.* More than 90,000 Delta Dental PPO dentists and 161,000 Delta Dental Premier locations in the U.S.* Access You must visit your assigned dentist to receive benefits Ability to change assigned dentist monthly via telephone or Internet Freedom to visit any licensed dentist — no need to select a primary care dentist Change dentists any time without contacting Delta Dental Selecting a dentist All covered procedures have predetermined copayments so out-of-pocket costs are predictable Covered services paid at percentage of contract allowance (for example, 80%) Coinsurance / Copayment DeltaCare ® USA PPO Features
    19. 19. Choosing Between a PPO and a Prepaid Plan DeltaCare ® USA PPO Features No claim forms Claim forms filed by Delta dentists Administration No annual deductible and no annual dollar maximums Annual deductibles and maximums apply Deductibles and Maximums Plan covers out-of-area (35 or more miles from assigned DeltaCare ® USA dentist) emergency care allowance up to $100 per incident Visit any licensed dentist With more than 161,000 Delta dentists nationwide it’s easy to find a Delta dentist Out-of-Area coverage Wide range of covered services, including orthodontia. Note: For Basic plan enrollees, the DeltaCare ® USA orthodontist will give a 25% discount off of filed fees. Wide range of covered services. Covered Benefits Easy referrals to a large number of specialty care dentists (referral from assigned dentist and preauthorization required) No referral required for specialty care Specialty Care
    20. 20. So I’ve Chosen a Plan – What Else Should I Know?
    21. 21. <ul><li>How do I obtain more information on our plans and benefits? </li></ul><ul><li>Open enrollment materials </li></ul><ul><li>Customer Service </li></ul><ul><li>Website </li></ul><ul><li>Intranet </li></ul><ul><li>How do I change DHMO dentists, how often can I change, what date of the month should I change by? </li></ul><ul><li>Change by calling customer service or via www.deltadentalins.com </li></ul><ul><li>Can change monthly </li></ul><ul><li>Change by the 20 th of the month prior (Aug 20 th for a Sept 1 change </li></ul>Helpful Hints
    22. 22. <ul><li>How do I save the most money out of my pocket with the PPO plan? </li></ul><ul><li>The easiest way to save money is to use the Delta PPO network. </li></ul><ul><li>If not using the PPO network then try to use a Delta Premier dentist </li></ul><ul><ul><li>Though out of network benefits will apply you will still save money over a non-Delta dentist </li></ul></ul><ul><li>When do I need a pre-authorization for the DHMO plan? </li></ul><ul><li>Only when visiting an in-network specialist </li></ul><ul><li>Your DeltaCare dentist will take care of this process for you </li></ul><ul><li>Are pre-treatment estimates required for the PPO plan? </li></ul><ul><li>Pre-treatment estimates or Pre-determinations are not required </li></ul><ul><li>They are performed as a free service to assist you with budgeting and determining the benefits to be applied. Your dentist will submit for you. </li></ul>Helpful Hints
    23. 23. <ul><li>What is the best way to reach customer service? </li></ul><ul><li>Telephone </li></ul><ul><ul><li>IVR or live support </li></ul></ul><ul><li>Email through www.deltadentalins.com </li></ul><ul><li>How can I be a better consumer? </li></ul><ul><li>Ask questions </li></ul><ul><li>Contact customer service for assistance </li></ul><ul><li>Utilize the website </li></ul><ul><ul><li>Treatment history </li></ul></ul><ul><ul><li>Fee finder </li></ul></ul><ul><ul><li>Dental terms </li></ul></ul><ul><li>Become familiar with your benefits </li></ul>Helpful Hints
    24. 24. <ul><li>Toll free number - (800) 422-4234 is available seven days a week. Choose from automated voice recordings or automated fax back. </li></ul><ul><li>Customer Service representatives available through our toll free number Monday through Friday. </li></ul><ul><li>Visit our web site at www.deltadentalins.com to </li></ul>DeltaCare ® USA Customer Service - The Experts You Can Turn To - Find a dentist & map directions - Check eligibility & benefits - Nominate your dentist to contract with DeltaCare ® USA - Obtain an ID card - Read dental health tips and articles - Visit SmileKids, a fun way for children to learn about oral health
    25. 25. Delta Dental PPO Customer Service – Helpful, Accessible, Dependable <ul><li>Call Delta Dental at (800) 521-2651, seven days a week. Choose from automated voice recordings or automated fax back. </li></ul><ul><li>Customer Service representatives available through our toll free number Monday through Friday. </li></ul><ul><li>Visit us on our web site at www.deltadentalins.com to </li></ul><ul><li>- Find a dentist & map directions </li></ul><ul><li>- Check eligibility & benefits </li></ul><ul><li>- View claims information </li></ul><ul><li>- Nominate your dentist for the PPO program </li></ul><ul><li>- Print an ID card and claim form </li></ul><ul><li>- Read dental health tips and articles </li></ul><ul><li>- Visit SmileKids, a fun way for children to learn about oral health </li></ul>
    26. 26. www.deltadentalins.com <ul><li>Screen shot </li></ul>
    27. 27. www.deltadentalins.com <ul><li>Screen shot </li></ul>
    28. 28. Delta Dental: We’ve got a plan that will keep you smiling. Delta Dental Insurance Company (Delta Dental) underwrites and administers Delta Dental PPO and Delta Dental Premier fee-for-service programs in Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada and Utah. In Texas, Delta Dental underwrites and administers DPO (Dental Provider Organization) programs. DeltaCare ® USA prepaid programs are underwritten in these states by these Delta Dental affiliates: AL – Alpha Dental of Alabama, Inc.; FL, GA - Delta Dental Insurance Company; TX - Alpha Dental Programs, Inc.; NV - Alpha Dental of Nevada, Inc.; UT – Alpha Dental of Utah, Inc.. Delta Dental affiliate PMI Dental Health Plan acts as the DeltaCare ® USA administrator in all these states. These companies are financially responsible for their own products.
    29. 29. THANK YOU

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