Transcript Title of Presentation

Dental Plan Benefits
August, 2015
Administered by
Delta Dental of New Mexico
We do dental. Better.
UNM Hospitals Dental Plan
Provider Network Overview – Point-of-Service Plan
One Plan, two network choices!
Plan Participants can select any dentist in either the Delta Dental Premier® or
Delta Dental PPOSM network at the time dental services are received.
Delta Dental PPOSM
Delta Dental Premier®
Over 1,800 of
access in New Mexico
Almost 2,100 points of
access in New Mexico
Over 234,000 dentist
locations nationally
Over 315,000 dentist
locations nationally
Select a Delta Dental PPO dentist to help
reduce patient out-of-pocket costs.
Select a Delta Dental Premier dentist
if you prefer or if specialty care is needed
and not available in Delta Dental PPO.
Find a Dentist
Log on deltadentalnm.com to search for a dentist.
 Pre-selection of a dentist is not required and every member of your family may visit a
different dentist.
 There is no need to contact Delta Dental to change your dentist; you may change as often
as you like.
 Whenever possible, use in-network dentists. Discounts do not apply to out-of-network
providers.
Lower out-of-pocket costs, and important member protections apply when services are received in-network!
UNM Hospitals Dental Plan
Provider Network Overview – Point-of-Service Plan
The illustration below shows how the reduced
Maximum Approved Fees for Delta Dental PPO
can result in significant patient savings.
Example assumes Procedure Code 2790
(Crown—Full Cast High Noble Metal)
Dentist Submitted
Charge
Delta Dental Maximum
Approved Fee (networkspecific)
Participant Pays
(50% Co-payment for
Major Services)
Delta Dental PPO
Provider
Delta Dental Premier
Provider
$1,142
$1,142
$809
$1,025
$404.50
(50% of $809)
$512.50
(50% of $1,025)
UNM Hospitals Dental Plan
Dental Plan Benefits Overview
Calendar Year Deductible
$50 per enrolled person
$150 aggregate per family
Does not apply to Diagnostic, Preventive, or Orthodontic Services
Calendar Year Maximum
$1,200 per enrolled person
Separate Lifetime Maximum apply to Orthodontic Services
UNM Hospitals Dental Plan
Dental Plan Benefits Overview
Delta Dental PPOSM
Delta Dental Premier®
Diagnostic and Preventive Services – No Deductible
Covered Oral Exams & Cleanings (2 per Calendar
Year), X-rays, Fluoride Application, Emergency
Treatment, Sealants, Space Maintainers, and
Diagnostic Casts
Delta Dental
Pays 100%
You
Pay 0%
Delta Dental
Pays 100%
You
Pay 0%
Delta Dental
Pays 80%
You
Pay 20%
Delta Dental
Pays 80%
You
Pay 20%
Delta Dental
Pays 50%
You
Pay 50%
Delta Dental
Pays 50%
You
Pay 50%
Basic Services
Fillings, Stainless steel crowns, Extractions, Oral
Surgery, Root canals, Periodontics (surgical or
non-surgical), and General Anesthesia
Major Services
Onlays, Crowns, Bridges, Partials or Complete
dentures, Specified Implant Procedures
Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees.
UNM Hospitals Dental Plan
Orthodontic Benefit Overview
ORTHODONTIC SERVICES (child and adult)
No deductible
Delta Dental Pays 50%
up to $1,000 lifetime maximum
Enrollees Pay 50%
plus balance of cost up to the applicable
Delta Dental Maximum Approved Fee
Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees.
UNM Hospitals Dental Plan
Predetermination of Benefits
ASK YOUR DENTIST FOR A
PRE-TREATMENT ESTIMATE when
more costly procedures are anticipated.
 An advance estimate of benefits
before dental care services are
received
 Not required, but strongly
recommended
 No charge for this service
Patient Disclosure –
You’re entitled to it!
UNM Hospitals Dental Plan
Website Resources
Member Information
Available 24/7
•View / Print Coverage
Documents & Provider
Directories
•Verify eligibility of subscriber
and dependents
•Confirm status of deductibles
and plan maximums
•Review how a specific claim
was processed
•Print a personalized subscriber
ID card
Contact us at www.deltadentalnm.com
UNM Hospitals Dental Plan
Customer Service
Contact Us
Automated voice response benefit information available all hours
Experienced Customer Service Representatives
Available Monday – Friday 8:00 AM - 4:30 PM (MST)
505-855-7111 or Toll Free 1-877-395-9420
Email: [email protected]
Mobile Application
To download the new mobile
app, visit the
App Store (Apple) or Google
Play (Android)
and search for “Delta Dental”
We do dental. Better.
UNM Hospitals Rates
Per Pay Period (24/Year)
COVERAGE TYPE
Employee
Employee COST
Full Time
Employee COST
Part Time
$0.00
$6.10
Employee + 1
$17.50
$23.60
Employee + 2 or more
$33.50
$39.60