Transcript Non-Network Dentists

Odessa School District Dental Benefits
Effective July 1, 2013
•Opportunity to make changes/enroll
•Base & Buy-Up Plans
NOTE: Current dental plan members will
automatically be enrolled in their current plan for
next year unless you submit an enrollment form
to switch plans or terminate coverage.
•Buy-Up plan includes a $1500 annual benefit
maximum and 100% coverage for Diagnostic &
Preventive Services in or out of PPO network
•Both plans continue to include access to both
Delta Networks—Delta Dental PPO & Delta Dental
Premier
Selecting a Dentist
Delta Dental PPO and
Delta Dental Premier Dentists
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Delta Dental Contracted Provider
Discounted Fees In-Network**
No Balance Billing
No Claim Forms
Direct Dentist Reimbursement
**Discounts are deepest in the PPO
network
Network Status of Odessa Dentists:
•Dr. Jerry Haney - Delta Dental PPO Network
•Dr. Scott Heriford - Delta Dental Premier Network only
Non-Network Dentists
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Not Under Contract With Delta
No Discounted Fees
Balance Billing is Possible
Not Obligated To File Claims
Patient Reimburses Dentist
Delta Dental
PPO Network
Dentist
Delta Dental
Premier Network
Dentist
Non-Network
Dentist
Deepest Discounts
Discounts
No Discounts
No balance billing
No balance billing
Balance billing is
possible
Diagnostic and Preventive Services
100%
80%
80%
Basic Restorative Services
80%
80%
80%
Major Restorative Services
50%
50%
50%
Child Orthodontic Services
(to age 19)
50%
50%
50%
Base Plan
Co-Insurance (Plan Pays)
Calendar Year Deductible
$50 per person / $150 family limit
Applies to:
B & C Services
Calendar Year Benefit Maximum
Separate Lifetime Orthodontic
Maximum
Dependent Age Limit
$1,000 per person
$1,000 per eligible dependent child
End of the calendar year in which your dependent turns 26
This is intended to be a summary only. Refer to the Dental Benefit Highlights
document provided in your handout for more detail on services covered under
each class and plan limitations.
Delta Dental
PPO Network
Dentist
Delta Dental
Premier Network
Dentist
Non-Network
Dentist
Deepest Discounts
Discounts
No Discounts
No balance billing
No balance billing
Balance billing is
possible
Diagnostic and Preventive Services
100%
100%
100%
Basic Restorative Services
90%
80%
80%
Major Restorative Services
60%
50%
50%
Child Orthodontic Services
(to age 19)
50%
50%
50%
Buy-Up Plan
Co-Insurance (Plan Pays)
Calendar Year Deductible
$50 per person / $150 family limit
Applies to:
B & C Services
Calendar Year Benefit Maximum
Separate Lifetime Orthodontic
Maximum
Dependent Age Limit
$1,500 per person
$1,000 per eligible dependent child
End of the calendar year in which your dependent turns 26
This is intended to be a summary only. Refer to the Dental Benefit Highlights
document provided in your handout for more detail on services covered under
each class and plan limitations.
Technology
Questions?
1-800-335-8266
• Live reps from 7am to 5pm Monday through Friday
• Benefit24 VRU (Virtual Response Unit)
– Faxback – summary of benefits
[email protected]
• Email your questions
www.deltadentalmo.com
• Self-serve website
Technology
www.deltadentalmo.com
Self-serve features:
–Network provider search
–Claims status and history
–Copy of EOB
–Benefit design
–Track use of maximums
–Print ID cards
–Request an ID card