BS_DeltaDentalPresentation.ppt

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  • I will briefly review your benefits.
  • BS_DeltaDentalPresentation.ppt

    1. 1. Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division State of New Mexico General Services Department Risk Management Division Administered by Delta Dental of New Mexico Dental Plan Benefits Effective July, 2008
    2. 2. GSD/RMD Dental Plan Provider Network Overview <ul><li>Delta Dental has several dentist networks. </li></ul><ul><li>In-Network: PPO New Mexico is exclusively available to NMIBAC enrollees, and is exclusively available in New Mexico. </li></ul><ul><li>In-Network: Delta Dental PPO dentists are considered in-network when services are received outside New Mexico. </li></ul><ul><li>Out-of-Network: Delta Dental Premier. Balance billing will apply, but will be less than if services were received from a dentist who does not participate in Delta Dental Premier. </li></ul><ul><li>Higher levels of benefits and lower out-of-pocket costs ALWAYS apply in-network! </li></ul>Whenever possible, use in-network dentists. On-line dentist search deltadentalnm.com Out-of-network dentists may balance bill patients for amounts over the Plan fee allowables. “ In-Network” providers outside of New Mexico Nationally, over 105,000 dentist locations These dentists will not bill patients for any amount over the Plan fee allowables. “ In-Network” providers in New Mexico Over 750 dentist locations statewide These dentists will not bill patients for any amount over the Plan fee allowables. Find a Dentist Delta Dental PPO PPONew Mexico
    3. 3. <ul><li>Calendar Year Deductible </li></ul><ul><li>Does not apply to Diagnostic & Preventive </li></ul><ul><li>Services or Orthodontic Services </li></ul><ul><li>$50 per enrolled person </li></ul><ul><li>$150 aggregate per family </li></ul><ul><li>Calendar Year Maximum </li></ul><ul><li>$1750 per enrolled person </li></ul>GSD/RMD Dental Plan
    4. 4. GSD/RMD Dental Plan Benefits Overview * Out of network dentists may balance bill patients for amounts over Plan fee allowables. <ul><li>Oral Examinations - twice in a calendar year </li></ul><ul><li>Cleanings - twice in a calendar year </li></ul><ul><li>X-rays: Full mouth -1 in 5 years / Bitewing - 2 in a calendar year </li></ul><ul><li>Fluoride Application - through age 18, twice per calendar year </li></ul><ul><li>Emergency Treatment </li></ul><ul><li>Space Maintainers - through age 18, 5 year limitation </li></ul><ul><li>Sealants - through age 15, permanent molars only, 3 year limit </li></ul>Plan Pays 100% no deductible You Pay: Any Amount Balance Billed * Plan Pays 100% no deductible You Pay: 0% Diagnostic and Preventive Services Out-of-Network In-Network Benefit
    5. 5. GSD/RMD Dental Plan Benefits Overview * Out of network dentists may balance bill patients for amounts over Plan fee allowables. <ul><li>Amalgam or composite resin fillings </li></ul><ul><li>Extractions – surgical/non-surgical </li></ul><ul><li>Periodontics - non-surgical / surgical treatment of gum disease </li></ul><ul><li>Endodontics - pulp therapy and root canal filling </li></ul><ul><li>Repair of implants, dentures and bridgework </li></ul><ul><li>General Anesthesia - intravenous sedation & general anesthesia </li></ul><ul><li>Oral Surgery </li></ul><ul><li>Stainless steel crowns </li></ul>Plan Pays 55% deductible applies You Pay: 45% plus Balance Billing * Plan Pays 80% deductible applies You Pay: 20% Basic Services Out-of-Network In-Network Benefit
    6. 6. GSD/RMD Dental Plan Benefits Overview * Out of network dentists may balance bill patients for amounts over Plan fee allowables. <ul><li>Inlays, Onlays, Crowns and Cast Restorations – when teeth cannot be restored with amalgam or composite resin restorations </li></ul><ul><li>Prosthodontics – Bridges, partials or complete dentures </li></ul><ul><li>Implants – specified services and related prosthodontics, subject to clinical review/approval </li></ul>Plan Pays 35% deductible applies You Pay: 65% plus Balance Billing * Plan Pays 60% deductible applies You Pay: 40% Major Services Out-of-Network In-Network Benefit
    7. 7. GSD/RMD Dental Plan Benefits Overview Out of network dentists may balance bill patients for amounts over Plan fee allowables. Children -- up to 18 th birthday Plan Pays 75% up to a $2000 lifetime maximum Adults -- age18 and over Plan Pays 60% up to a $1750 lifetime maximum ORTHODONTIC SERVICES No deductible Out-of-Network In-Network Benefit
    8. 8. Patient Disclosure – You’re entitled to it! <ul><ul><li>PPO NEW MEXICO Dentist’s Guarantee </li></ul></ul><ul><li>Upon request, a pre-treatment cost range will be provided by your dentist. </li></ul><ul><li>You and your dentist agree. </li></ul><ul><li>Pre-determination of benefits from Delta Dental is recommended (not required) for expensive procedures. </li></ul>GSD/RMD Dental Plan Patient Disclosure
    9. 9. GSD/RMD Dental Plan Information Available 24/7!   <ul><li>Online access to personalized benefit information, oral health information, privacy policies and more. No software to purchase or download required. </li></ul><ul><li>Featured Plan Information Available at deltadentalnm.com in the Subscriber Section </li></ul><ul><li>Go to Subscriber Materials, then sign in with your group number (8523). View, print, or save coverage documents: </li></ul><ul><li>Summary of Benefits </li></ul><ul><li>Dental Benefit Handbook </li></ul><ul><li>Network Information Page </li></ul><ul><li>PPO New Mexico Provider Directory </li></ul><ul><li>Consumer Toolkit </li></ul><ul><li>Select the Consumer Toolkit link, sign in, and: </li></ul><ul><li>Verify eligibility of subscriber and dependents </li></ul><ul><li>Confirm status of deductibles and plan maximums </li></ul><ul><li>Review how a specific claim was processed </li></ul><ul><li>Print a personalized subscriber ID card </li></ul>www.deltadentalnm.com
    10. 10. <ul><li>Experienced Benefit Service Representatives </li></ul><ul><li>Available Monday – Friday 8:00 AM - 4:30 PM (MST) </li></ul><ul><li>505-855-7111 or Toll Free 1-877-395-9420 </li></ul>GSD/RMD Dental Plan Customer Service All claims and customer services provided locally. No frustrating phone “menu of options” from which to choose. Talk to a local representative within 45 seconds of calling! Great service is our way of saying “ Thank you for your enrollment.” www.deltadentalnm.com

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