delta dental
TRANSCRIPT
Benefits Contacts In-service
Dental Benefits
July 29, 2008
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YOUR DELTA DENTAL TEAM
Keith Edwards, Sales Account Executive
Paulette Blinn, Account Manager
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The Benefits of Choice
• Four great Delta Dental options from which to choose
• Choose between the DeltaCare®USA Low Plan FLM74 or High Plan FL15B
• and the Dental PPO High or Low Plan
• Coverage begins according to eligibility date
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DeltaCare®USA Prepaid Plan
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DeltaCare®USA Plan Highlights
Patient pays pre-specified copayment for each covered procedure (no copay required for routine exams and cleanings).
Patient can select a dentist at enrollment.
Specialty care provided by specialists requires preauthorization (referral).
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DeltaCare®USA Plan Highlights
Enrollees cannot receive benefits if care is provided by dentist who is not the selected provider.
No deductibles or annual maximums.
No (or very low) copayments for diagnostic and preventive services.
Fixed copayments for basic and major services on the DeltaCare®USA High Plan.
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Visiting a Specialist with DeltaCare®USA High Plan
• General dentist determines work needs to be done beyond his/her scope of expertise.
• Dentist submits request for pre-authorization to plan administrator.
• Plan administrator authorizes procedure(s).
• Dentist provides referral to DeltaCare®USA specialist.
• Specialty care performed by a specialist must be authorized before work is performed, and must be done by a DeltaCare-approved specialist.
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Visiting a Specialist with DeltaCare®USA Low Plan
• General dentist determines work needs to be done beyond his/her scope of expertise.
• Dentist submits request for pre-authorization to plan administrator.
• Plan administrator authorizes procedure(s).
• Dentist provides referral to DeltaCare®USA specialist.
• Low Plan enrollees receiving specialty care are eligible for a 25% discount if services are provided by a DeltaCare®USA specialist.
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Prepaid Plan Designs
Example Only
Procedure High Plan
Low Plan
0120 Oral Exam No cost No cost
1110 Adult Cleaning No cost No cost
2330 Filling $22 $28
2752 Crown $335 $465
5110 Complete dentures $365 $510
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How do I find a DeltaCare®USA dentist?
• Visit www.deltadentalins.com to search by name, address, specialty. Print directories and driving directions.
• Call (800) 422-4234. Our automated information line provides voice information or can fax a list of dentists, whichever you prefer.
• Requests for dentist changes received by the 15th of the month will become effective the first of the following month.
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Delta Dental PPO
Delta Dental Insurance Company
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Delta Dental PPO Plan Highlights
Freedom of choice – patient can visit any dentist.
Reduced fee-for-service: Maximize savings by utilizing PPO (in-network) dentists.
Nationwide coverage – visit any licensed dentist anywhere in the world.
Visiting a Delta Dental PPO (in-network) dentist usually saves patients almost 30% on average out-of-pocket costs.
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Delta Dental PPO Plan Highlights
• Visiting a Delta Dental Premier (out-of-network) dentist usually saves patients almost 20% on average out-of-pocket costs.
• Visiting a non-Delta (out-of-network) dentist may cost you more in out-of-pocket expenses – the dentist has not agreed to provide services at reduced fees.
• Maximums and deductibles apply.
• Reimbursement for each procedure is based on coinsurance – the enrollee pays a percentage and the insurer pays a percentage.
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Delta Dental PPO High Plan Highlights
Benefits And Covered Services * PPO Dentist** Non-Delta Dentist**
WHO’S ELIGIBLE Primary enrollee, spouse and eligible dependent children to age 25
DEDUCTIBLES $50 per enrollee, $150 per family, per calendar year
DEDUCTIBLE WAIVED FOR DIAGNOSTIC & PREVENTIVE? Yes
ANNUAL MAXIMUM The maximum benefit paid per plan year is $1,500 per person
DIAGNOSTIC & PREVENTIVE BENEFITS -- Oral examinations, cleanings, x-rays, fluoride treatment, space maintainers 100 % 100 %
BASIC BENEFITS -- Fillings, denture repairs, Endodontics (root canals), Periodontics (gum treatment) , Oral Surgery 80 % 80 %
MAJOR BENEFITS -- Crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, full dentures) 50 % 50 %
ORTHODONTICS * 50% 50%
ORTHODONTIC MAXIMUMS $1,000 $1,000
*Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Evidence of Coverage or Summary Plan Description for waiting periods and a list of benefit limitations and exclusions.**Fess are based on PPO fees for in-network dentists and for out-of-network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist's actual fees.
Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions.
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Delta Dental PPO Low Plan Highlights
Benefits And Covered Services * PPO Dentist** Non-Delta Dentist**
WHO’S ELIGIBLE Primary enrollee, spouse and eligible dependent children to age 25
DEDUCTIBLES $50 per enrollee, $150 per family, per calendar year
DEDUCTIBLE WAIVED FOR DIAGNOSTIC & PREVENTIVE? Yes
ANNUAL MAXIMUM The maximum benefit paid per plan year is $1,000 per person
DIAGNOSTIC & PREVENTIVE BENEFITS -- Oral examinations, cleanings, x-rays, fluoride treatment, space maintainers 100 % 100 %
BASIC BENEFITS -- Fillings, denture repairs, Endodontics (root canals), Periodontics (gum treatment) , Oral Surgery 70 % 70 %
MAJOR BENEFITS -- Crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, full dentures) 40 % 40 %
ORTHODONTICS * 40% 40%
ORTHODONTIC MAXIMUMS $1,000 $1,000
*Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Evidence of Coverage or Summary Plan Description for waiting periods and a list of benefit limitations and exclusions.**Fess are based on PPO fees for in-network dentists and for out-of-network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist's actual fees.
Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions.
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• Delta Dental offers PPO enrollees a unique feature – Premier dentists, which provides additional cost protections for our PPO plans.
• If you can’t visit a PPO dentist, Premier dentists usually can save you money over visiting a non-Delta Dental dentist. (Low Plan)
Unique Cost Savings: The Delta Difference®
Procedure:PPO
(in-network) Dentist Non-PPO
(out-of-network) Dentist
Dentist bills $180.00 $180.00
Delta Dental’s plan allowance $ 90.00$180.00
No fee agreement with Delta Dental
Delta Dental’s payment $ 45.00 $45.00
Patient payment* $ 45.00 $135.00
Patient saves $ 90.00 No patient savings
*Patient’s share is the coinsurance/copayment, any remaining deductible, any amount over the annual maximum and any services your plan does not cover
Amounts shown are for illustrative purposes only. Actual amounts may vary by provider and region.
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How do I find a dentist for my Dental PPO plan?
• Visit www.deltadentalins.com to search by name, address, specialty. Print directories and driving directions.
• Call (800) 521-2651. Our automated information line provides voice information or can fax a list of dentists, whichever you prefer.
• Ask your dentist if they are a contracting PPO dentist.
• If you do not find a PPO dentist, your next best option is to search for a Premier dentist.
• Visit the dentist of your choice – it’s that easy.
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Choosing Between a PPO and a Prepaid Plan
Features PPO DeltaCare®USA
Coinsurance / Copayment Covered services paid at percentage of contract allowance (for example, 80%)
All covered procedures have predetermined copayments so out-of-pocket costs are predictable
Selecting a dentist
Freedom to visit any licensed dentist — no need to select a primary care dentist
Change dentists any time without contacting Delta Dental
You must visit your assigned dentist to receive benefits
Ability to change assigned dentist monthly via telephone or Internet
Access More than 90,000 Delta Dental PPO dentists and 161,000 Delta Dental Premier locations in the U.S.*
More than 20,000 DeltaCare®USA offices in the U.S.*
Contracting Dentists
You usually have the lowest out-of-pocket expenses when visiting a Delta Dental PPO dentist
If you don’t see a PPO dentist, a Delta Dental Premier dentist is usually your next best option
Visit your assigned DeltaCare dentist to receive benefits
Pay only the copayment at the time of treatment. Note: Enrollees on Basic plan have a 25 discount off the filed fees when a DeltaCare®USA specialist is used.
* As of June, 2006
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Features PPO DeltaCare®USA
Specialty Care No referral required for specialty careEasy referrals to a large number of specialty care dentists (referral from assigned dentist and preauthorization required)
Covered BenefitsWide range of covered services. Wide range of covered services, including orthodontia.
Note: For Basic plan enrollees, the DeltaCare®USA orthodontist will give a 25% discount off of filed fees.
Out-of-Area coverage
Visit any licensed dentist
With more than 161,000 Delta dentists nationwide it’s easy to find a Delta dentist
Plan covers out-of-area (35 or more miles from assigned DeltaCare®USA dentist) emergency care allowance up to $100 per incident
Deductibles and Maximums Annual deductibles and maximums apply No annual deductible and no annual dollar maximums
Administration Claim forms filed by Delta dentists No claim forms
Choosing Between a PPO and a Prepaid Plan
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So I’ve Chosen a Plan – What Else Should I Know?
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How do I obtain more information on our plans and benefits?
• Open enrollment materials
• Customer Service
• Website
• Intranet
How do I change DHMO dentists, how often can I change, what date of the month should I change by?
• Change by calling customer service or via www.deltadentalins.com
• Can change monthly
• Change by the 20th of the month prior (Aug 20th for a Sept 1 change
Helpful Hints
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How do I save the most money out of my pocket with the PPO plan?
• The easiest way to save money is to use the Delta PPO network.
• If not using the PPO network then try to use a Delta Premier dentist
•Though out of network benefits will apply you will still save money over a non-Delta dentist
When do I need a pre-authorization for the DHMO plan?
• Only when visiting an in-network specialist
• Your DeltaCare dentist will take care of this process for you
Are pre-treatment estimates required for the PPO plan?
• Pre-treatment estimates or Pre-determinations are not required
• They are performed as a free service to assist you with budgeting and determining the benefits to be applied. Your dentist will submit for you.
Helpful Hints
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What is the best way to reach customer service?
• Telephone
•IVR or live support
• Email through www.deltadentalins.com
How can I be a better consumer?
• Ask questions
• Contact customer service for assistance
• Utilize the website
•Treatment history
•Fee finder
•Dental terms
• Become familiar with your benefits
Helpful Hints
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• Toll free number - (800) 422-4234 is available seven days a week. Choose from automated voice recordings or automated fax back.
• Customer Service representatives available through our toll free number Monday through Friday.
• Visit our web site at www.deltadentalins.com to
DeltaCare®USA Customer Service - The Experts You Can Turn To
- Find a dentist & map directions
- Check eligibility & benefits
- Nominate your dentist to contract withDeltaCare®USA
- Obtain an ID card
- Read dental health tips and articles
- Visit SmileKids, a fun way for children to learn about oral health
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Delta Dental PPO Customer Service – Helpful, Accessible, Dependable
• Call Delta Dental at (800) 521-2651, seven days a week. Choose from automated voice recordings or automated fax back.
• Customer Service representatives available through our toll free number Monday through Friday.
• Visit us on our web site at www.deltadentalins.com to
- Find a dentist & map directions
- Check eligibility & benefits
- View claims information
- Nominate your dentist for the PPO program
- Print an ID card and claim form
- Read dental health tips and articles
- Visit SmileKids, a fun way for children to learn about oral health
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www.deltadentalins.com
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www.deltadentalins.com
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Delta Dental:We’ve got a plan that will keep you smiling.
Delta Dental Insurance Company (Delta Dental) underwrites and administers Delta Dental PPO and Delta Dental Premier fee-for-service programs in Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada and Utah. In Texas, Delta Dental underwrites and administers DPO (Dental Provider Organization) programs.
DeltaCare®USA prepaid programs are underwritten in these states by these Delta Dental affiliates: AL – Alpha Dental of Alabama, Inc.; FL, GA - Delta Dental Insurance Company; TX - Alpha Dental Programs, Inc.; NV - Alpha Dental of Nevada, Inc.; UT – Alpha
Dental of Utah, Inc.. Delta Dental affiliate PMI Dental Health Plan acts as the DeltaCare®USA administrator in all these states. These companies are financially responsible for their own products.
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THANK YOU