Lincoln Intermediate Unit #12 Your Delta Dental Benefits Plan


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Lincoln Intermediate Unit #12 Your Delta Dental Benefits Plan

  1. 1. Lincoln Intermediate Unit #12 Your Delta Dental Benefits Plan
  2. 2. Who is Delta Dental? <ul><li>#1 provider of dental benefits in the United States </li></ul><ul><li>Covers over 51 million members; 93,000 groups nationwide </li></ul><ul><li>The first organization designed to provide group dental benefits – still our one and only specialty </li></ul><ul><li>Three out of four dentists nationally participate </li></ul><ul><li>Local offices in Mechanicsburg, PA </li></ul>
  3. 3. The Delta Dental Advantage <ul><li>Largest dentist network in the U.S. </li></ul><ul><ul><li>3 out of 4 dentists participate with Delta Dental </li></ul></ul><ul><li>Freedom of choice with Delta Dental PPO plus Premier </li></ul><ul><ul><li>Select any dentist you want, but save more money by choosing a </li></ul></ul><ul><ul><li>Delta Dental dentist </li></ul></ul><ul><li>User-Friendly Service: </li></ul><ul><ul><li>Call toll-free (800-932-0783) every business day, 8 a.m. to 8 p.m. (EST) </li></ul></ul><ul><ul><li>Visit Delta Dental online at: </li></ul></ul><ul><li>Quality Control </li></ul><ul><ul><li>Delta Dental makes sure the care you receive is necessary and effective </li></ul></ul>
  4. 4. The Delta Dental Advantage <ul><li>Lower Out-Of-Pocket Costs </li></ul><ul><ul><li>Delta Dental’s allowances mean lower costs to you </li></ul></ul><ul><ul><li>Delta Dental dentists will not charge any more than applicable copayments and deductibles for covered services </li></ul></ul><ul><li>Claims Convenience </li></ul><ul><ul><li>Delta Dental dentists submit claim forms for you and Delta Dental pays the dentist directly </li></ul></ul><ul><li>Quick Claims Processing </li></ul><ul><ul><li>Delta Dental typically processes claims in 10 calendar days or less </li></ul></ul>
  5. 5. Delta Dental PPO plus Premier <ul><li>LIU has access to combined networks of participating dentists who participate in Delta Dental PPO and Delta Dental Premier networks </li></ul><ul><li>You have complete freedom to choose: </li></ul><ul><ul><li>A dentist who participates in Delta Dental PPO Premier network or </li></ul></ul><ul><ul><li>A dentist who does not participate with Delta Dental </li></ul></ul><ul><li>Savings are determined by your choice </li></ul>
  6. 6. LIU Dental Benefits <ul><li>Delta Dental effective January 1, 2009 </li></ul><ul><li>Same LIU dental plan </li></ul><ul><li>No need to re-enroll </li></ul><ul><li>ID cards </li></ul><ul><ul><li>Each enrollee will receive two dental cards </li></ul></ul><ul><ul><li>Additional cards from Delta Dental’s web site, </li></ul></ul><ul><ul><li>ID card is not required to receive treatment – your dentist simply calls Delta Dental to confirm eligibility </li></ul></ul>
  7. 7. LIU Dental Plan Delta Dental PPO plus Premier *Note: Percentages are based on applicable Delta Dental allowances. None Yearly Deductible $1,000 per person based on calendar year Annual Maximum 50% 50% 50% 50% Orthodontics (for dependents to the end of the month in which they attain age 19) 0% 100% 0% 100% Denture Repair 0% 100% 0% 100% Simple Extractions 20% 80% 20% 80% Prosthodontics (Construction and repair of fixed bridges, partial or complete dentures) 20% 80% 20% 80% Major Restorative (Inlays, onlays, crowns) Professional staff: $2,000 per person All other staff: $1,000 per person Orthodontic Lifetime Maximum 20% 80% 20% 80% Periodontics (Surgical & non-surgical treatment of gum disorders) 0% 100% 0% 100% Endodontics ( Root canal therapy) 20% 80% 20% 80% Oral Surgery (Extractions) 0% 100% 0% 100% Basic Restorative (Fillings) 0% 100% 0% 100% Preventive (Cleanings, sealants, space maintainers, fluoride treatments) 0% 100% 0% 100% Diagnostic (Exams and x-rays) Paid by Patient* Paid by Delta Dental* Paid by Patient* Paid by Delta Dental* Non-Participating Dentist Delta Dental Premier Dentist Covered Benefit
  8. 8. Delta Dental PPO plus Premier Payment Example Note: These are hypothetical numbers for illustrative purposes only. Assume no maximum or deductibles are applicable. $280 ($1,000 - $720 = ) $150 ($750 - $600 = ) Patient Payment 80% 80% Copayment Amount $720 $600 Delta Dental Payment $900 $750 Sample Plan Payment Allowance $0 $130 ($280 - $150 = ) Patient Savings (over non-Delta Dental dentist) $1,000 $1,000 Dentist’s Charge for a Crown (Example ) Non-Participating Dentists Delta Dental PPO Premier Dentists Example
  9. 9. Pretreatment Estimate <ul><li>Determine costs ahead of time by asking your dentist to submit a predetermination before treatment is provided </li></ul><ul><li>Delta Dental provides an estimate of the cost of treatment and what we will pay </li></ul><ul><li>This free service helps you and your dentist make informed decisions about the cost of treatment </li></ul>
  10. 10. Work In Progress <ul><li>Procedures performed after January 1 are paid by Delta Dental. </li></ul><ul><li>Procedures with dates of service prior to January 1 - other than orthodontic procedures – are paid by NCAS </li></ul><ul><li>For orthodontics, Delta Dental has received orthodontic history from NCAS and reviews date treatment began and the amount already paid toward the treatment </li></ul><ul><li>Delta Dental pays no more than the lifetime amount </li></ul>
  11. 11. Is YOUR Dentist a Delta Dental Dentist? <ul><ul><li>If not… </li></ul></ul><ul><ul><li>Delta Dental will recruit non-participating dentists on your behalf by targeting specific dentists in any location </li></ul></ul><ul><ul><li>Delta Dental encourages you to make referrals; recruitment cards can be made available </li></ul></ul>
  12. 12. Customer Service <ul><li>Toll-free “800” telephone number, including staffing by expert bilingual representatives; 97% of inquiries resolved on first call </li></ul><ul><li>Delta Dental’s Interactive Voice Response System (IVR) gives you and your dentist access to eligibility and benefit information after hours </li></ul><ul><li>Free predeterminations (pre-treatment estimates) </li></ul><ul><li>Notices of Payment </li></ul>
  13. 13. Customer Service: Hours <ul><li>Looking for a Delta Dental participating dentist near you? </li></ul><ul><li>Want to know your program benefits? </li></ul>Call Delta Dental (800) 932-0783 8:00 a.m. to 8 :00 p.m. (Eastern Time) Monday through Friday
  14. 14. Online Services From Delta Dental’s Web Site <ul><li>Easy-to-use participating dentist directories for all networks with maps and driving directions </li></ul><ul><li>Secure login for benefits and eligibility lookup </li></ul><ul><ul><li>Access information on program benefits, eligibility, status of deductibles, maximum usage, and claim status </li></ul></ul><ul><li>Fee Finder for common procedures </li></ul><ul><li>Printable claim forms </li></ul><ul><li>Printable ID cards </li></ul><ul><li>SmileKids – an interactive site for children </li></ul><ul><li>Extensive dental health section </li></ul><ul><li>E-mail inquiries to customer service </li></ul><ul><li>Enrollee section in Spanish </li></ul>
  15. 15. Dentist Locator & Map with Directions
  16. 16. Eligibility & Benefits
  17. 17. Claim Status Ability to check in-progress and processed claims.
  18. 18. Dental Fee Finder <ul><li>Allows you to obtain estimates of the average cost of common dental procedures in your area by entering the first three digits of your ZIP code. </li></ul>
  19. 19. Our site for children provides interactive games, coloring pages, teeth facts and other educational tools.
  20. 20. <ul><li>Delta Dental has largest dentist network in U.S. </li></ul><ul><ul><li>Excellent access to Delta Dental dentists </li></ul></ul><ul><li>Member Savings </li></ul><ul><ul><li>Delta Dental’s PPO Premier network offers freedom of choice, dentist access and savings opportunities for you </li></ul></ul><ul><li>Member-friendly services </li></ul><ul><ul><li>No balance billing on claims of Delta Dental dentists </li></ul></ul><ul><ul><li>No claim forms with Delta Dental dentists </li></ul></ul><ul><ul><li>Prompt claims processing </li></ul></ul><ul><ul><li>Customer Service for Delta Dental PPO Premier available 8 a.m. to 8 p.m. (EST) Monday through Friday </li></ul></ul><ul><ul><li>IVR services available after hours </li></ul></ul><ul><li>Internet services </li></ul><ul><ul><li>Easy-to-use participating dentist directories for all networks </li></ul></ul><ul><ul><li>Secure login for benefits and eligibility lookup </li></ul></ul>What the Delta Dental Difference ® Means to YOU
  21. 21. We keep you smiling. ®