Transcript Monterey Bay Public Employees Trust Regional Hospitals of

Overview of Dental Benefits 2014
by Delta Dental of California –
Certificated Teachers
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
No I.D. Cards. No claim forms.
•
Locate a Delta dentist by visiting
deltadentalca.org or calling 1-800-427-3237.
•
Make an appointment and tell the dentist
you are a Delta member.
•
Bring the name of your employer (Salinas
Union H.S. District) and Group Number (13170013) with you.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
You can keep your dental expenses down by:
• Comparing the fees of different dentists;
• Using a Delta dentist;
• Having your dentist obtain predetermination from Delta for any
treatment over $300.00;
• Visiting your dentist regularly for checkups;
• Following your dentist’s advice about regular brushing and
flossing;
• Avoiding putting off treatment until you have a major problem.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Calendar Year Benefit Maximums
• Diagnostic, Preventive, Basic, Restorative, and Prosthodontic:
$1,500.00 (non PPO for each enrollee.
$2,000.00 ( PPO dentist ) for each enrollee.
• Dental Accident: $1,000.00 for each enrollee; this Benefit is
separate from the other Benefits.
Lifetime Benefit Maximums
• Orthodontic: $1,000.00 for each enrollee.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Increasing Benefits Program
• Delta will pay 70% of the Covered Fees for the Diagnostic,
Preventive, Basic, Crown, and Restorative Benefits during the first
(1st) year of eligibility;
• This percentage increases 10% each consecutive year the
dentist is visited to a maximum of 100%;
• If you don’t visit your dentist in any calendar year, the
percentage remains at the level you reached the previous year;
• If you reestablish eligibility after losing it, the percentage
returns to 70%.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Diagnostic Benefits (70%-100%)
• Oral examinations (maximum of two (2) in any calendar year);
x-rays (once every three (3) years; bitewing x-rays once in any
calendar year to adults- two (2) times a year to children);
diagnostic casts; examination of biopsied tissue; palliative
(emergency) treatment of dental pain; specialist consultation.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Preventative Benefits (70%-100%)
• Prophylaxis (cleaning); fluoride treatment; space maintainers.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Basic Benefits (70%-100%) (slide 1 of 5)
• Oral Surgery:
extractions and certain other surgical
procedures, including pre- and post-operative care;
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Basic Benefits (70%-100%) (slide 2 of 5)
• Restorative:
amalgam, silicate, or composite (resin)
restorations (fillings) for treatment of carious lesions (visible
destruction of hard tooth structure resulting from the process of
dental decay);
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Basic Benefits (70%-100%) (slide 3 of 5)
• Endodotic: treatment of the tooth pulp;
• Periodontic: treatment of gums and bones that support the
teeth;
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Basic Benefits (70%-100%) (slide 4 of 5)
• Sealants:
topically applied acrylic, plastic, or composite
material used to seal developmental grooves and pits in teeth for
the purpose of preventing dental decay (limited to eligible
dependent children under the age of fourteen(14)) not including
the repair or replacement of a sealant on a tooth within three (3)
years of its application;
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Basic Benefits (70%-100%) (slide 5 of 5)
• Adjunctive General Services: general anesthesia; office visit
for observation; office visit after regularly scheduled hours;
therapeutic
drug
injection;
treatment
of
post-surgical
complications
(unusual
circumstances);
limited
occlusal
adjustment.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Crowns, Jackets, Inlays, Onlays, and Cast
Restoration Benefits (70%-100%)
• Benefits only if they are provided to treat cavities which cannot
be restored with amalgam, silicate, or direct composite limited to
once every five years on the same tooth unless replacement is
required because the restoration is unsatisfactory due to poor
quality of care or extensive loss of tooth structure or supporting
tissue since the replacement of the restoration.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Prosthodontic Benefits
• Construction or repair of fixed bridges, partial dentures, and
complete dentures if provided to replace missing, natural teeth
once every five (5) years unless there has been such an extensive
loss of remaining teeth or a change in supporting tissue that the
existing appliance cannot be made satisfactory. (Paid at 70%
every year with no increasing annual level of benefit.)
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Orthodontic Benefits
• Procedures using appliances or surgery to straighten or realign
teeth, which otherwise would not function properly. (Paid at 50%
every year with no increasing annual level of benefit to a lifetime
maximum of $1,000.00.)
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Dental Accident Benefits
• Any services which would be covered under other Benefit
categories when they are provided for conditions caused directly
by external, violent, or accidental means. (Paid at 100% every
year with an annual maximum of $1,000.00.)
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Rates (effective 4/01/2014)
• $101.71 per month (composite rate – same rate for Single,
Single+1, or Full Family).
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Certificated Teachers
Disclaimer
•
This presentation provides only a general overview of your Dental benefits;
• For complete information, consult your copy of the Combined Evidence of Coverage
and Disclosure Form or contact either Delta Dental (1-800-427-3237 or
www.deltadentalca.org) or Health Services & Benefit Administrators (1-831-7571711 or 1-888-742-3380).
Back to Delta Dental Benefit Page