Lincoln Intermediate Unit #12Your Delta Dental Benefits Plan
Who is Delta Dental?
#1 provider of dental benefits in the United States
Covers over 51 million members; 93,000 groups nationwide
The first organization designed to provide group dental benefits – still our one and only specialty
Three out of four dentists nationally participate
Local offices in Mechanicsburg, PA
The Delta Dental Advantage
Largest dentist network in the U.S.• 3 out of 4 dentists participate with Delta Dental
Freedom of choice with Delta Dental PPO plus Premier• Select any dentist you want, but save more money by choosing a Delta Dental dentist
User-Friendly Service: Call toll-free (800-932-0783) every business day, 8 a.m. to 8 p.m.
(EST)
Visit Delta Dental online at: www.deltadentalins.com
Quality Control• Delta Dental makes sure the care you receive is necessary and
effective
The Delta Dental Advantage
Lower Out-Of-Pocket Costs• Delta Dental’s allowances mean lower costs to you
• Delta Dental dentists will not charge any more than applicable copayments and deductibles for covered services
Claims Convenience• Delta Dental dentists submit claim forms for you and Delta Dental
pays the dentist directly
Quick Claims Processing• Delta Dental typically processes claims in 10 calendar days or less
Delta Dental PPO plus Premier
LIU has access to combined networks of participating dentists who participate in Delta Dental PPO and Delta Dental Premier networks
You have complete freedom to choose:
A dentist who participates in Delta Dental PPO Premier network or
A dentist who does not participate with Delta Dental
Savings are determined by your choice
LIU Dental Benefits
Delta Dental effective January 1, 2009
Same LIU dental plan
No need to re-enroll
ID cards Each enrollee will receive two dental cards
Additional cards from Delta Dental’s web site, www.deltadentalins.com
ID card is not required to receive treatment – your dentist simply calls Delta Dental to confirm eligibility
LIU Dental Plan Delta Dental PPO plus Premier
*Note: Percentages are based on applicable Delta Dental allowances.
Covered Benefit
Delta Dental Premier Dentist
Non-Participating Dentist
Paid by Delta Dental*
Paid by Patient* Paid by Delta Dental*
Paid by Patient*
Diagnostic (Exams and x-rays) 100% 0% 100% 0%
Preventive (Cleanings, sealants, space maintainers, fluoride treatments)
100% 0% 100% 0%
Basic Restorative (Fillings) 100% 0% 100% 0%
Oral Surgery (Extractions) 80% 20% 80% 20%
Endodontics (Root canal therapy) 100% 0% 100% 0%
Periodontics (Surgical & non-surgical treatment of gum disorders)
80% 20% 80% 20%
Major Restorative (Inlays, onlays, crowns) 80% 20% 80% 20%
Prosthodontics (Construction and repair of fixed bridges, partial or complete dentures)
80% 20% 80% 20%
Denture Repair 100% 0% 100% 0%
Simple Extractions 100% 0% 100% 0%
Orthodontics (for dependents to the end of the month in which they attain age 19) 50% 50% 50% 50%
Yearly Deductible None
Annual Maximum $1,000 per person based on calendar year
Orthodontic Lifetime MaximumProfessional staff: $2,000 per person
All other staff: $1,000 per person
Delta Dental PPO plus Premier Payment Example
Example Delta DentalPPO Premier Dentists
Non-ParticipatingDentists
Dentist’s Charge for a Crown (Example)
$1,000 $1,000
Sample Plan Payment Allowance $750 $900
Copayment Amount 80% 80%
Delta Dental Payment $600 $720
Patient Payment$150
($750 - $600 = )
$280($1,000 - $720 = )
Patient Savings
(over non-Delta Dental dentist)
$130($280 - $150 = )
$0
Note: These are hypothetical numbers for illustrative purposes only. Assume no maximum or deductibles are applicable.
Pretreatment Estimate
Determine costs ahead of time by asking your dentist to submit a predetermination before treatment is provided
Delta Dental provides an estimate of the cost of treatment and what we will pay
This free service helps you and your dentist make informed decisions about the cost of treatment
Work In Progress
Procedures performed after January 1 are paid by Delta Dental.
Procedures with dates of service prior to January 1 - other than orthodontic procedures – are paid by NCAS
For orthodontics, Delta Dental has received orthodontic history from NCAS and reviews date treatment began and the amount already paid toward the treatment
Delta Dental pays no more than the lifetime amount
Is YOUR Dentist a Delta Dental Dentist?
If not…
Delta Dental will recruit non-participating dentists on your behalf by targeting specific dentists in any location
Delta Dental encourages you to make referrals; recruitment cards can be made available
Customer Service
Toll-free “800” telephone number, including staffing by expert bilingual representatives; 97% of inquiries resolved on first call
Delta Dental’s Interactive Voice Response System (IVR) gives you and your dentist access to eligibility and benefit information after hours
Free predeterminations (pre-treatment estimates)
Notices of Payment
Customer Service: Hours
Looking for a Delta Dental participating dentist near you?Want to know your program benefits?
Call Delta Dental
(800) 932-0783 8:00 a.m. to 8:00 p.m.
(Eastern Time)
Monday through Friday
Online Services From Delta Dental’s Web Site
Easy-to-use participating dentist directories for all networks with maps and driving directions
Secure login for benefits and eligibility lookup• Access information on program benefits, eligibility,
status of deductibles, maximum usage, and claim status
Fee Finder for common procedures Printable claim forms Printable ID cards SmileKids – an interactive site for children Extensive dental health section E-mail inquiries to customer service Enrollee section in Spanish
www.deltadentalins.comwww.deltadentalins.com
Dentist Locator & Map with Directions
Eligibility & Benefits
Claim Status
Ability to check in-progress and processed claims.
Dental Fee Finder
Allows you to obtain estimates of the average cost of common dental procedures in your area by entering the first three digits of your ZIP code.
www.KeepKidsSmiling.com
Our site for children provides interactive games, coloring pages, teeth facts and other educational tools.
Delta Dental has largest dentist network in U.S. • Excellent access to Delta Dental dentists
Member Savings• Delta Dental’s PPO Premier network offers freedom of choice, dentist access and
savings opportunities for you
Member-friendly services• No balance billing on claims of Delta Dental dentists
• No claim forms with Delta Dental dentists
• Prompt claims processing
• Customer Service for Delta Dental PPO Premier available 8 a.m. to 8 p.m. (EST) Monday through Friday
• IVR services available after hours
Internet services• Easy-to-use participating dentist directories for all networks
• Secure login for benefits and eligibility lookup
What the Delta Dental Difference®
Means to YOU
We keep you smiling.®
www.deltadentalins.com