Transcript Monterey Bay Public Employees Trust Regional Hospitals

Overview of 2014 Dental
Benefits
provided to
Retiree groups by
Delta Dental of California
Monterey Bay Public Employees Trust
Overview of 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
Calendar Year Benefit Maximums
• Diagnostic, Preventive, Basic, Restorative, and Prosthodontic:
$1,500.00 (non PPO dentist) for each enrollee.
$2,000.00 (PPO dentist) for each enrollee
$1,000.00 for each enrollee; this Benefit is
separate from the other Benefits.
• Dental Accident:
Lifetime Benefit Maximums
• Orthodontic: $1,000.00 for each enrollee.
Monterey Bay Public Employees Trust
Overview of 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
Preventative Benefits (70%-100%)
• Prophylaxis (cleaning); fluoride treatment; space maintainers.
Monterey Bay Public Employees Trust
Overview of 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 2014 Dental Benefits
(Delta Dental of California) - Certificated
Rates (effective 4/01/2014)
• Single $42.83
•Two Party $89.69
•Family $136.53
Monterey Bay Public Employees Trust
Overview of 2014 Dental Benefits
(Delta Dental of California) - Certificated
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 (1-831-757-1711 or 1-888-7423380).