Transcript Title of Presentation

Dental Plan Benefits
August, 2010
Administered by
Delta Dental of New Mexico
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 PPO network at the time dental services are received.
Delta Dental PPOSM
Delta Dental Premier®
Select a Delta Dental PPO dentist to help
reduce patient out-of-pocket costs.
Select a Delta Dental Premier dentist if your dentist
or specialist only participates in this network.
817 points of
access in New Mexico
Over 1,180 points of
access in New Mexico
Over 138,900 dentist
locations nationally
Almost 220,000 dentist
locations nationally
Find a Dentist
Log on to 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.
Lower out-of-pocket costs, and important member protections apply when services are received in-network!
UNM Hospitals Dental Plan
Dental Plan Benefits Overview
Calendar Year Deductibles
$50 per enrolled person
$150 aggregate per family
• Does not apply to Diagnostic & Preventive Services
• Does not apply to Orthodontic Services
Calendar Year Maximums
• $1,200 per enrolled person per benefit period
Separate Lifetime Maximums 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
PREDETERMINATION OF BENEFITS
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
Special Eligibility Provisions
Please remember…
 If you enroll one dependent (spouse/domestic partner/child), you
must enroll all dependents except children under the age of 3 with
proof of other coverage.
 Children are covered through age 18
 Full-time students are covered through
age 24 (verification of full-time student
status must be provided to UNMH
Human Resources)
UNM Hospitals Dental Plan
Information Available 24/7!
Enrollees have online access to personalized benefit information, oral health information,
privacy policies and more. No software to purchase or download required.
Featured Plan Information Available at deltadentalnm.com in the Subscriber Section
Subscriber Materials are accessed with the UNMH group number (4101).
Enrollees may view, print, or save coverage documents:
 Summary of Benefits
 Dental Benefit Plan Provisions
 Provider Directory
Consumer Toolkit
Enrollees may also select Consumer Toolkit and sign in to:
• 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
www.deltadentalNM.com
UNM Hospitals Dental Plan
Customer Service
 Dental plan claims and administration
services provided in New Mexico
 Experienced Benefit Representatives
•
•
•
•
Available Monday – Friday
8:00am-4:30pm
Albuquerque 505-855-7111
Toll free 1-877-395-9420
Over 95% of calls answered
in fewer than 45 seconds
UNM Hospital Dental Rates
Per Pay Period(24/Year)
COVERAGE TYPE
Employee
EE COST
Full Time
$
EE COST
Part Time
0.00
$ 6.10
Employee + 1
$ 17.50
$ 23.60
Employee + 2 or more
$ 33.50
$ 39.60