TRUST YOUR SMILE TO

DELTA DENTAL2020 Open EnrollmentCounty of San Bernardino Retirees

What we’ll cover

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To enroll, complete and submit a County of San Bernardino Retiree Dental Plan Enrollment/ Change Form and submit to EBSD by mail or fax at:

Employee Benefits and Services Division157 West Fifth Street, First FloorSan Bernardino, CA 92415-0440Fax: 909-387-5566 Attn: Retiree Desk

I. Your Dental Plans Effective 1/1/2020

- DeltaCare USA Program (DHMO)- Delta Dental PPO Program

- Low & High Plan Comparison- Diagnostic & Preventive Max Waiver - Cost Estimator

II. Wellness BenefitsIII. Questions

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24 Month EnrollmentRequirement1. You are eligible to enroll as an Enrollee/Dependent if you meet the

eligibility requirements defined by the County of San Bernardino.

2. By electing retiree dental, retiree agrees to remain enrolled for a minimum of 24 consecutive months subject to:

• Retirees electing either the DHMO or Low DPPO plans can switch between the DHMO and the Low DPPO at annual Open Enrollment.

• Retirees electing the High DPPO must remain enrolled in the High DPPO a minimum of 24 consecutive months.

3. The 24 month enrollment requirement is offset for all prior months an enrollee has been continuously covered under a retiree dental plan.

4. Retirees wishing to cancel dental coverage at annual Open Enrollment are only eligible to do so after achieving 24 months continuous dental coverage.

New Entrant Waiting Period

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For the Low Dental PPO and High Dental PPO plans only, a 12-month waiting period for Class III (major restorative) services is applicable to any County retiree who incurs a gap in coverage.

1. The waiting period is waived for any retiree and covered dependent that remains continuously covered when transitioning from active to retiree dental coverage.

2. Retirees who previously had COBRA benefits but did not re-enroll (resulting in a gap in coverage) are subject to the dental waiting period.

DeltaCare® USA

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How DeltaCare USA worksGetting dental care is easy

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COVEREDPROCEDURES

300+

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We’ve Got You CoveredPredictable costs

• Pay only your copay (if any)• Enjoy no deductibles• Don’t worry about maximums

No claim forms

Minimal limitations and exclusions

Out-of-area emergency allowance

Specialty care with referral

Choice of your own network dentist

If you need specialty care,

your primary care dentist

will refer you

Your primary care dentist

requests authorization for

specialty services

Plan includes out-of-

network coverage for

emergencies

DeltaCare USA

Specialty and Emergency Care

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1. Go to deltadentalins.com to browse the DeltaCare USA dentists in your area.

2. Write down the facility number of the primary care dentist you would like.

3. Submit your request.

Online: Create an online account at deltadentalins.com

By phone: Call Customer Service at 855-244-7323

DeltaCare USA

How to Pick Your Dentist

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Delta Dental PPO™

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Delta Dental PPO Maximize your savings with a PPO dentist

When you visit a Delta Dental contracted dentist:

• No claim form

• You won’t be charged more than your expected share of the bill

See any licensed dentist

We’ll coordinate dual coverage

Your Smile is Covered

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*Low PPO plan covers prosthesis over implant• Diagnostic & Preventive services do not count towards your Annual Maximum.Texas plans have different coinsurance levels, refer to your County summaries for plan detail

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Enhanced PPO

benefitComparePPO Plan Summaries

Save the most with PPO

Claims Example

Most claims savings Some claims savings No claims savings

In-Network

Delta Dental PPOOut-of-Network

Delta Dental Premier

Out-of-Network

Non-Delta Dental

Dentists

Dentist’s Charge for

a Crown $1,200 $1,200 $1,200

Plan Allowance $700 $900 $950

Percentage Paid by Plan 50% 50% 50%

Plan Payment $350 $450 $475

PATIENT PAYMENT$350

($700 - $350 =)

$450

($900 - $450 =)

$725

($1,200 - $475 =)

Note: Amounts listed for illustrative purposes only. Assumes no maximum or deductibles are applicable.

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The Choice is Yours

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PPO Dual Network Advantage

160,000 network dentists

352,000 locations

8 in 10 U.S. dentists are in a

Delta Dental PPO or Premier network

35-41%average discount

PPO network

Premier network

9-29%average discount

2 levels of savings:

1. Go to deltadentalins.com.

2. Look for the Find a Dentist tool on

the right.

3. Search by name, address, landmark,

city or ZIP code.

4. Select your network plan.

5. Click Search.

6. Narrow your search by location,

specialty, network and language.

7. Your search results will include a

dentist’s Yelp rating, address and

phone number.

Use the online dentist search tool

Find a Network Dentist

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What if I’m in the middle of dental work and want to change plans?

Coverage begins on your effective date

There are no exclusions for pre-existing conditions or missing teeth

Treatment started before 1/1/2020 will continue to be covered by your current dental plan. (PPO versus DeltaCare)

For example:

• Root canals• Crowns• Fixed bridges and partial dentures

Transition of Care

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We’ve got you covered

Determines costs ahead

of timeHelps you

make informed decisions Everything is

handled by your dentist

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Pre- Treatment Estimate

Personalized. Estimates are

based on your benefits,

including maximums and

deductibles.

Insightful. Compare the cost of

the same procedure at different

dentists.

Economical. See how choosing

an in-network dentist can help

you save.

Available on desktop and mobile

Cost Estimator-(PPO only)

Budget for dental expenses

with personalized estimates

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Check your plan details:

eligibility, covered services

and level of benefits.

Look up claim statements for

recent dental visits.

View or print your ID card.

Estimate the cost of your next

procedure.

Submit questions to Customer

Service.

Sign Up for anOnline AccountCheck your benefits information online

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Go MobileDownload the app to have all the information you need at your fingertips

Find a dentist

Coveragedetails

Electronic ID card

Costestimator

Musical timer

What can you do with the app?

✓ ✓ ✓ ✓ ✓

To find the app, visit the App Store or Google Play and search for “Delta Dental.” Then download the Delta Dental app by Delta Dental Plans Association.

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Convenience. Get an email

alert every time a new

document is available.

Efficiency. No need to wait

for “snail mail.”

Save paper. Reduce your

ecological footprint.

Log in to your account at

deltadentalins.com, click on the

My Profile tab and select the

Online setting.

Go PaperlessView your documents online: claims, pre-treatment estimates and plan details

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WELLNESS BENEFITS

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Wellness Benefits-PPO Low PlanEnhanced benefits for enrollees, spouses and dependent children with one of the following chronic inflammation-related medical conditions: diabetes, heart disease, stroke, HIV/AIDS and rheumatoid arthritis (Must opt-in “Optional Benefits” through enrollee portal)

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Standard Coverage SmileWay® Wellness BenefitsDelta Dental PPO™

80% in-network/60% out-of-network for periodontal scaling and root planing procedure per quadrant (D4341 or D4342)

100% for 1 periodontal scaling and root planing procedure per quadrant (D4341 or D4342) per calendar year

100% in-network/70% out-of-network for 4 per calendar year:• prophylaxis (teeth cleaning)(D1110 or D1120)• scaling in presence of moderate or severe

gingival inflammation (D4346)• periodontal maintenance procedures (D4910)

100% for 4 of the following (any combination) per calendar year:• prophylaxis (teeth cleaning) (D1110 or D1120)• scaling in presence of moderate or severe

gingival inflammation (D4346)• periodontal maintenance procedure (D4910)

Wellness Benefits-PPO High PlanEnhanced benefits for enrollees, spouses and dependent children with one of the following chronic inflammation-related medical conditions: diabetes, heart disease, stroke, HIV/AIDS and rheumatoid arthritis (Must opt-in “Optional Benefits” through enrollee portal)

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Standard Coverage SmileWay® Wellness BenefitsDelta Dental PPO™

100% in-network/90% out-of-network for 1 periodontal scaling and root planing procedure per quadrant (D4341 or D4342) per 24 months

100% for 1 periodontal scaling and root planing procedure per quadrant (D4341 or D4342) per calendar year

100% for 2 per calendar year:• prophylaxis (teeth cleaning)(D1110 or D1120)100% in-network/90% out-of-network for 4• scaling in presence of moderate or severe

gingival inflammation (D4346)• periodontal maintenance procedures (D4910)

100% for 4 of the following (any combination) per calendar year:• prophylaxis (teeth cleaning) (D1110 or D1120)• scaling in presence of moderate or severe

gingival inflammation (D4346)• periodontal maintenance procedure (D4910)

How to Opt in- Enrollee Portal

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Wellness Benefits (continued)How to opt-in for your PPO Wellness Benefit

• www.deltadentalins.com

• Online Services- set up username and password to access your

personal benefit information

• Click on View Benefits

• Click on Optional Services

• Smileway Wellness Benefits

• Actions – Opt In

Requires you to select enrollee’s primary condition

Confirm info is accurate

Add name of physician

Add phone number of physician

Click on Opt-in to finalize your update

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Wellness Benefits- DHMO Plan

Member copays waived on the following benefits for patients with

diabetes, heart disease, stroke, HIV/AIDS and rheumatoid arthritis

(Report your qualifying condition to your dental office. Benefits

determined by contract dentist):

• Prophylaxis cleanings- 100% for 4 cleanings instead of 2 per cal

year

• Periodontal maintenance- 100% for 4 cleanings instead of $20

copay, per cleaning

• Scaling and root planning- 100% for 4 quadrants, per year

instead of $25 copay, per quadrant

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24/7 online access to benefits and eligibility

Dedicated Customer Service Number

855-244-7323

Nominate a provider to contract with

Delta Dental

www.deltadentalins.com

Our service is all

About You

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We’re pleased to take your questions

Thanks for your time