Transcript Salinas Education Center Certificated

Overview of
Dental Benefits
by Delta Dental of California –
Salinas Education Center Certificated
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 (1317-0005) with you.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center Certificated
Calendar Year Benefit Maximums
• Diagnostic, Preventive, Basic, Restorative, and Prosthodontic:
$1,000.00 for each enrollee.
• Dental Accident: $1,000.00 for each enrollee; this Benefit is separate from
the other Benefits.
Lifetime Benefit Maximums
• Orthodontic: None.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center Certificated
Preventative Benefits (70%-100%)
• Prophylaxis (cleaning); fluoride treatment; space maintainers.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center Certificated
Basic Benefits (70%-100%) (slide 3 of 5)
• Endodontic: 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)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center 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 50% every year with no increasing annual level of benefit.)
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center Certificated
Orthodontic Benefits
• None.
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 Dental Benefits (Delta Dental)
Salinas Education Center Certificated
Rates (effective 4/01/2014)
• $77.93 per month (composite rate – same rate for Single, Single +1, or Full
Family).
Monterey Bay Public Employees Trust
Overview of Dental Benefits (Delta Dental)
Salinas Education Center 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 (1831-757-1711 or 1-888-742-3380).