Post on 05-Oct-2021
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• Provideinforma6ononplanchanges• Provideyourcostshareforcovereddentalservices• Highlightthetypeofprovidersthatofferyouthe
bestvalue• Illustratepaymentexamples• Showyouhowtogetinforma6on
aboutyourplan• Demonstrateonlinetools• Answerques6ons
GoalsforToday
Changeseffec7veJanuary1,2018
• Introduc6onofa$50perpersondeduc6ble• Applieswhenservicesareprovidedbyaden6stnotinthe
DeltaDentalPPOnetwork• Appliestobasicandmajorservicesonly
YourCoinsurance
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DeltaDentalPPOden7st
DeltaDentalPremierornonpar7cipa7ngden7st
Diagnos7candpreven7veservicesTwocleanings,examsandfluoride(toage21)percalendaryear
5% 10%
BasicservicesRestora6veservices
X-rays—5%Fillings—20%Allother—25%
25%Deduc&bleisappliedfor
basicservices
MajorservicesProsthodon6cservicesImplants
50%50%
Deduc&bleisappliedformajorservices
Apre-treatmentes7matesubmiQedtoDeltaDentalallowsyoutolearnaboutyourtreatmentop7ons.
Some7melimitsexist.
YourMaximumsandDeduc7ble
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Annualmaximum(percalendaryear)Appliestodiagnos6candpreven6veservices,basicservices,andmajorservicesbenefits
$1,100
Orthodon7cmaximum(life7memaximum)Appliestoorthodon6cbenefits $1,200
Deduc7bleAppliestobasicandmajorservicesprovidedden6stnotintheDeltaDentalPPOnetwork
$50/person
Yourre7rementsystem’sdentalplanhasacarveoutclauseforCoordina7onofBenefits(COB)whentheplanpayssecondary.CheckouttheLearningCenterforaddi7onalprintedmaterials.
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YourDentalPlanOffersChoices
• Freedomtochooseanyden6st– DeltaDentalPPOSM
– DeltaDentalPremier®– Nonpar6cipa6ng
• Plandesignedtoofferthemaximumbenefitwiththelowestout-of-pocketexpensewhenyouuseDeltaDentalPPOden6sts
• YouwilllikelypaymorewhenyouuseaDeltaDentalPremierornonpar6cipa6ngden6st
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• ProvidersacceptDeltaDental’sPPOapprovedamountaspaymentinfull—youonlypayyourcoinsurance
• Nobalancebilling• Providersarepaiddirectly• ProvidersabidebyDeltaDental’s
processingpolicies
• Highestbenefitlevel• Nodeduc(ble
DeltaDentalPPO(PreferredProviderOrganiza7onProgram)
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DeltaDentalPremier
• Providerspar6cipatewithDeltaDental,butdonotacceptthelowerDeltaDentalPPOapprovedamount—youpayyourcoinsuranceplusanyaddi6onalamountsfornotusingaDeltaDentalPPOnetworkprovider
• AllowedtochargethedifferencebetweenDeltaDentalPPOapprovedandDeltaDentalPremierapprovedamounts
• NobalancebillingbetweentheDeltaDentalPremierapprovedamountandthesubmi_edamount
• Providersarepaiddirectly• ProvidersabidebyDeltaDental’sprocessingpolicies• Deduc(bleappliestobasicandmajorservices
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Nonpar7cipa7ng
• Providersdonotpar6cipatewithDeltaDentalandwilllikelycostyouthemostmoney—youpayyourcoinsuranceplusanyaddi6onalcostsuptotheprovider’scharge
• Balancebilling• Deduc(bleappliestobasicandmajorservices
• Youmayhavetosubmitclaims
10Source:DeltaDentalPlansAssocia6on,April2017
ProviderComparison
DeltaDentalPremier® 340,500+loca7ons
152,626+uniqueden7sts
• Youpayyourcoinsuranceplusanyaddi6onalamountsfornotusingaDeltaDentalPPOprovider
• NobalancebillingbetweentheDeltaDentalPremierapprovedamountandthesubmi_edamount
• Acceptanceofprocessingpolicies• Deduc(bleappliestobasicand
majorservices
• Youpayyourcoinsuranceplusanyaddi6onalamountsuptotheprovider’scharge
• Balancebilling• Deduc(bleapplies
tobasicandmajorservices
• Youonlypayyourcoinsurance• Nobalancebilling• Acceptanceofprocessingpolicies• Nodeduc(ble
DeltaDental
DeltaDentalPPOSM
269,800+loca7ons104,467+uniqueden7sts
Nonpar7cipa7ng
MajorServices(crown)PaymentExample(WithDeduc7ble)
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Providertype Charge Approvedamount
Membercostshare
Youpay
Deduc7bleCoinsurance
(PercentofDeltaDentalPPOapproved)
Addi7onalcost
DeltaDentalPPOden7st $950 $675 $0 + $168.75
(25%of$675) + $0 $168.75
DeltaDentalPremierden6st $950 $898 $50 + $156.25
(25%of$625*) + $223** $429.25
Nonpar6cipa6ngden6st $950 $950 $50 + $156.25
(25%of$625*) + $275*** $481.25
*DeltaDentalPPOapprovedamountminusthe$50deduc6ble**DifferencebetweentheDeltaDentalPPOandDeltaDentalPremierapprovedamount***DifferencebetweentheDeltaDentalPPOapprovedamountandnonpar6cipa6ngden6stcharge
Diagnos7candPreven7vePaymentExample(WithoutDeduc7ble)
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Providertype Charge Approvedamount
Membercostshare
Youpay
Deduc7bleCoinsurance
(PercentofDeltaDentalPPOapproved)
Addi7onalcost
DeltaDentalPPOden7st $90 $55 NONE + $2.75
(5%of$55) + $0 $2.75
DeltaDentalPremierden6st $90 $77 NONE + $5.50
(10%of$55) + $22* $27.50
Nonpar6cipa6ngden6st $90 $90 NONE + $5.50
(10%of$55) + $35** $40.50
*DifferencebetweentheDeltaDentalPPOandDeltaDentalPremierapprovedamount**DifferencebetweentheDeltaDentalPPOapprovedamountandnonpar6cipa6ngden6stcharge
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Formoredetailedinstruc7on,visitthe
LearningCenterforademo.
FindingaProvider
Formoredetailedinstruc6on,visittheLearningCenterfora
demo.
Choosethespecialty
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ConsumerToolkit®SecureOnlineAccess24/7
• Verifyeligibilitystatus
• Confirmaddress
• Accessbenefitoverview
• View/printEOBs
• PrintpersonalizedIDcards
• Checkannualmaximumusedtodate
• Readoralhealthinforma6on
• SignupforelectronicEOBs
ExtranetSite
ThelinktothistoolislocatedontheOfficeofRe7rementServiceswebsiteunderdentalbenefits.Itcanalsobeaccesseddirectlyat:hQp://www.deltadentalmi.com/MPSERS• Accessspecificinforma6onaboutyourre6rementsystem
dentalplan• Accesswri_enplandocumenta6on• Viewthispresenta6on• Searchtheden6stdirectoryforaprovider• LinktotheConsumerToolkit
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MobileSmartphoneApp
• Verifyeligibilityandbenefits• Findaden6st• ViewIDcard• UsetheToothbrushTimer
AvailableforAppleiOSorAndroidusers.VisittheAppStore(Apple)orGooglePlay(Android)andsearchfor‘DeltaDental.’Or,scanthisQRcodetodownloadtheapp.
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VisittheLearningCenter
• Askspecificques6onsregardingyourbenefits• Demothefollowingtools:
– ConsumerToolkit– DeltaDentalPlanofMichiganwebsite– Re6rementSystemextranetpage– Mobileapp
• Gatherhealthinforma6onflyers
JustforFun• Thestrongestmuscleinthebodyis……• Nexttothecommoncold,whatisthemostprevalentdiseaseintheUnited
States?• WhatcityinMichiganwasthefirstU.S.communitytofluoridateitspublic
drinkingwaterin1945?• Howmuchspitdoestheaveragehumanproduceinalife6me?• Howmanymusclesdoesittaketosmile?Tofrown?• Ifyoudon’tfloss,whatpercentofyourtoothsurfacesdoyoumiss
cleaning?
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Savethatsmile!• Brushatleasttwiceadaywitha
fluoridetoothpaste• Flossregularly• Avoidtheuseoftobaccoandlimitalcohol
toreduceyourriskoforalhealthproblems• Drinkfluoridatedwater• Keepupwithregulardentalvisits• Talktoyourden6stifyouno6ceany
changesorabnormali6es
HealthandWellness
Contac7ngDeltaDental
• Tollfree:800-345-8756– Advisors
• Available8:30a.m.–8:00p.m.(EST),Monday–Friday
– DASI(automatedsystem)• Available24hoursaday,sevendaysaweek• Providesbenefit,claims,eligibilityinforma6on,DeltaDental’smailingaddressandthenamesofDeltaDentalPPOandDeltaDentalPremierden6stsnearyou
• www.deltadentalmi.com/MPSERS
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