Transcript Delta Dental PPO

Odessa School District
2015 Open Enrollment
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Broad Network Protection with Delta Dental
Selecting a Dentist
Delta Dental PPO &
Delta Dental Premier Dentists
- Delta Dental Contracted Providers
- Discounted Fees In-Network**
- No Balance Billing
- No Claim Forms
- Delta Pays Dentist Directly
Non-Participating Dentists
- Not Under Contract With Delta Dental
- No Discounted Fees
- Balance Billing is Possible
- Dentists May Not File Claims
- Delta Dental Pays Patient
**Delta Dental PPO providers typically offer the greatest discounts.
**Plan coverage is higher when you use a Delta Dental PPO provider.
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Benefit Overview – BASE PLAN
Delta Dental PPO
←Greatest Patient Savings
Least Patient Savings
→
Delta Dental
PPO Network
Dentist
Delta Dental
Premier Network
Dentist
Non-Participating
Dentist
Type A: Diagnostic and Preventive Services
(exams, cleanings, x-rays, fluoride, sealants)
100%
80%
80%
Type B: Basic Restorative Services
(fillings, extractions, periodontal maintenance)
80%
80%
80%
Type C: Major Restorative Services
(periodontics, endodontics, crowns, dentures,
bridges)
50%
50%
50%
Type D: Child Orthodontic Services
(to age 19)
50%
50%
50%
Co-Insurance (Plan Pays)
Calendar Year Deductible
Applies to:
Calendar Year Benefit Maximum
Separate Lifetime Orthodontic Maximum
Dependent Age Limit
$50 per person / $150 family limit
B & C Services
$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. For more detailed information regarding covered services, limitations and exclusions consult your Summary Plan Description.
3
Benefit Overview – BUY UP PLAN
Delta Dental PPO
←Greatest Patient Savings
Least Patient Savings
→
Delta Dental
PPO Network
Dentist
Delta Dental
Premier Network
Dentist
Non-Participating
Dentist
Type A: Diagnostic and Preventive Services
(exams, cleanings, x-rays, fluoride, sealants)
100%
100%
100%
Type B: Basic Restorative Services
(fillings, extractions, periodontal maintenance)
90%
80%
80%
Type C: Major Restorative Services
(periodontics, endodontics, crowns, dentures,
bridges)
60%
50%
50%
Type D: Child Orthodontic Services
(to age 19)
50%
50%
50%
Co-Insurance (Plan Pays)
Calendar Year Deductible
Applies to:
Calendar Year Benefit Maximum
Separate Lifetime Orthodontic Maximum
Dependent Age Limit
$50 per person / $150 family limit
B & C Services
$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. For more detailed information regarding covered services, limitations and exclusions consult your Summary Plan Description.
4
Customer Service and Benefit Information
Questions?
Call:
1-800-335-8266
•Live reps from 7am to 5pm Monday through Friday
•Benefit24 VRU (Virtual Response Unit)
-Faxback – summary of benefits
Email:
[email protected]
Go online: www.deltadentalmo.com
•Self-serve Subscriber features:
•Online access 24/7
•Search for a Network Provider
•Track Use of Annual Maximum
•Print/Request ID Cards
•Claim Status and History
•Copies of EOBs
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