TRUST YOUR SMILE TO DELTA DENTAL 2017/2018 Open Enrollment County of San Bernardino Retirees
TRUST YOUR SMILE TO
DELTA DENTAL2017/2018 Open EnrollmentCounty of San Bernardino Retirees
I. Your Dental Plans Effective 1/1/2018
- DeltaCare USA Program (pre-paid DHMO)
- Delta Dental PPO Program
- What’s NEW for 2018
- Additional PPO option
- Cost Estimator
II. Wellness Benefits
III. Questions
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
1. 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 beginning 1/1/2018 must remain enrolled in the High DPPO for 24 consecutive months, through 12/31/2019.
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.
24 Month Enrollment Required
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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.
PPO – New Entrant Waiting Period
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DENTAL HEALTH QUIZ
How often should you replace your toothbrush?
Every 3 weeks
Once a year Once every 2 years
Every 3 months
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DENTAL HEALTH QUIZ
Replacing your toothbrush every 3 months prevents the growth of cold-causing bacteria and viruses
Every 3 weeks
Once a year Once every 2 years
Every 3 months
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DELTACARE®
USA
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Select a dentist Schedule
an appointmentReceive care
Pay
only your
copayment
GETTING STARTED IS EASYDeltaCare® USA
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Predictable 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
WE’VE GOT YOU COVERED
COVEREDPROCEDURES
300+
DeltaCare® USA
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NEED A SPECIALIST?
Visit your primary care dentist
Your dentist requests authorization for specialty services
You receive a referral to a specialist from your primary care dentist
DeltaCare® USA
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ORTHODONTICSDeltaCare® USA
All phases
Children and adults
Pre- and post- records
Tooth extractions
Treatment in progress coverage
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DeltaCare® USA
CHOOSE A DENTIST
Choose your own network dentist
Submit a County of San Bernardino Retiree Dental Plan
Enrollment/ Change Form and submit to EBSD by mail or fax
Changes throughout the year can be made:
Visit deltadentalins.com, log-in to enrollee portal to change your
network dentist online
Call Customer Service at 855-244-7323
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DELTA DENTAL PPOSM
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YOUR SMILE IS COVEREDwith Delta Dental PPOSM
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
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WHAT’S NEWPPO PLAN SUMMARY
• Diagnostic & Preventive services will no longer be counted against your Annual Maximum.• Member gains additional $300 to $500 in annual benefit when receiving exams, x-rays and cleanings.
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Enhanced benefit for 1/1/2018!
New plan option for 1/1/2018!
Service Category IN-NETWORK NON-NETWORK IN-NETWORK NON-NETWORK
Reimbursement Basis PPO FeePremier Fee or
80th UCRPPO Fee
Premier Fee or
80th UCR
Calendar Year Maximum and Deductible
Annual Maximum $1,000 $1,000 $1,700 $1,700
Diagnostic & Preventive Waived Annual Maximum Yes Yes Yes Yes
Annual Deductible (per Patient / per Family) $50/$150 $50/$150 $50/$150 $50/$150
Diagnostic & Preventive Waived Annual Deductible Yes Yes Yes Yes
Annual Deductible $50/$150 $50/$150 $50/$150 $50/$150
Coinsurance
Diagnostic & Preventive 100% 70% 100% 100%
Basic Restorative Services 80% 60% 100% 90%
Endodontics 80% 60% 100% 90%
Periodontics 80% 60% 100% 90%
Oral Surgery 80% 60% 100% 90%
Major Restorative Services 50% 50% 75% 70%
Implants N/A* N/A* 75% 70%
* Low PPO plan covers prosthesis over implant.
LOW PPO HIGH PPO
THE CHOICE IS YOURSSave 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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PPO DUAL NETWORKADVANTAGE1 product — 2 levels of savings
25-35% average discount
8-16% average discount
Premier NetworkPPO Network
IN NETWORK OUT-OF-NETWORK
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We’ve got you coveredPRE-TREATMENT ESTIMATE
Determines costs ahead
of timeHelps you
make informed decisions Everything is
handled by your dentist
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TRANSITION OF CAREWhat if I’m in the middle of dental work?
Coverage begins on your effective date
There are no exclusions for pre-existing conditions or missing teeth
Treatment started before 1/1/2018 will continue to be covered by CIGNA. For example:
• Root canals• Crowns• Fixed bridges and partial dentures
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TRANSITION OF CAREOrthodontia
PPO: Orthodontia is not a covered benefit.
DHMO: Within 30 days, submit your “Continuous Orthodontist Coverage Form” to continue treatment with your current orthodontist.
Contact customer service for assistance at 855-244-7323
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Less paper, more convenience
Conserve natural resources
Download or print documents
Access your plan information with ease and convenience
Visit deltadentalins.com/paperless
GO PAPERLESS
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Sign up for an
www.deltadentalins.com
Locate a network dentist
Check benefits and eligibility
Check claim status
Dental education resources
View or print your ID card
ONLINE ACCOUNT
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FIND A DENTIST ONLINEIt’s simple!
Go to deltadentalins.com and log in
Select “Find a Dentist”
Delta Dental PPO
DeltaCare USA
Search by name, address, landmark, city or ZIP code
Get a map and driving directions
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COST ESTIMATOR (PPO ONLY)Get a customized cost estimate
PersonalizedBased on your benefits, including the current status of maximums and deductibles
Easy to useSimple questions to guide you through the process
Based on real dataCalculated from your actual processed claims and updated daily
Available on desktop and mobile
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YOU’RE MOBILEand so are we!
Use the mobile site to:
Access your ID card
Check eligibility, benefits and claims
Find a dentist by your location
Manage your profile
Or, get the free app and you can also:
Get a cost estimate (PPO only)
Use a musical tooth brushing timer
Get the app from the App Store or Google PlayTM
Search for “Delta Dental”
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WELLNESS BENEFITS
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WELLNESS BENEFITSFor enrollees, spouses and dependent children with one of the following chronic inflammation-related medical conditions
PPO 100% coverage for one periodontal scaling and root planing procedure per quadrant per
calendar year (D4341 or D4342)
Four of the following (any combination) per calendar year:
Prophylaxis (teeth cleaning; D1110 or D1120), covered at 100%
Periodontal maintenance procedure (D4910) covered at 100%
Opt-in/sign-up for the Smileway Wellness Benefit on the benefits area of the Enrollee Portal
Additional services available to pregnant women are available outside the wellness benefits
Heart Disease
Stroke
Rheumatoid Arthritis
Diabetes
HIV/AIDS
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WELLNESS BENEFITS (CONTINUED)DHMO Frequency limitations and copayment (D1110, D1120, D4910) will be waived when
services are needed more frequently due to medical necessity as determined by the Contract Dentist
Enrollees will be charged the standard copay for additional cleanings that exceed two in a calendar year
For reimbursement, the enrollee must submit a copy of the network dentist’s billing statement, proof of payment and written verification of the qualifying medical condition
Delta Dental will update the enrollee’s record to show the additional benefit is approved; future medical verification will not be required
Delta Dental will mail a refund check to the enrollee
Pregnancy is a covered condition under the DHMO plan
Refund requests should be mailed to:DeltaCare USA – Account Services
Group 78853 Refund
17871 Park Plaza Drive, Suite 200
Cerritos, CA 90703
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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
ABOUT YOUOur service is all
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DENTAL HEALTH QUIZ
If you don’t floss, how much of a tooth’s surface is left unclean?
10 percent
25 percent 35 percent
18 percent
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DENTAL HEALTH QUIZ
According to the Centers for Disease Control, 35 percent of tooth surfaces are left unclean if regular brushing is not accompanied by flossing.
10 percent
25 percent 35 percent
18 percent
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We’re pleased to take your questions…
THANK YOU FORYOUR TIME
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