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Transcript of Delta Dental
Delta Dental of New Mexico
… administering the dental plan for
State of New MexicoGeneral Services DepartmentRisk Management Division
Improved Oral Health =Improved Overall Health
“Oral Health is Integral To Overall Health.”
“… studies have demonstrated an association between periodontal diseases and diabetes, cardiovascular disease, stroke, and adverse pregnancy outcomes.”
From the May, 2000 Surgeon General’s Report
GSD/RMD Dental Plan
Calendar Year Deductibles:
• Do not apply to Diagnostic & Preventive Care Services or to Orthodontic Services
$ 50 per enrolled person $150 aggregate per family
GSD/RMD Dental Plan
GSD/RMD Dental Plan
Calendar Year Maximum *:
$1750 per enrolled person
* A separate lifetime maximumapplies to Orthodontic Services
GSD/RMD Dental PlanProvider Network
PPONEW MEXICO SUBSCRIBERS ANDDEPENDENTS
Over 760 PPONEW MEXICOdentist locations statewide
Choose any in-networkdentist statewide
Dentists accept PPONEWMEXICO
dentist fees (no balance billing)
Pay only coinsurance and deductible (if any)
for covered services
On-line dentist searchdeltadentalnm.com
Each family member may choose a different dentist
Benefit In-Network Out-of-Network
Diagnostic and Preventive Services
Plan Pays 100%no deductibleYou Pay: 0%
Plan Pays 100% *no deductible
You Pay: Any Amount Balance Billed *
Oral Examinations - twice in a calendar year Cleanings - twice in a calendar year X-rays: Full mouth -1 in 5 years / Bitewing - 2 in a calendar year Fluoride Application - through age 18, twice per calendar year Emergency Treatment Space Maintainers - through age 18, 5 year limitation Sealants - through age 15, permanent molars only, 3 year limit
GSD/RMD Dental PlanBenefits Overview
* The approved fees applicable to non-participating providers are less than those applicable toPPONew Mexico dentists. Because non-network providers may balance bill patients for amounts above approved
fees, and because some benefit levels are lower when services are received from non-participating providers,out-of-pocket costs may be significantly higher if services are received out-of-network.
Benefit In-Network Out-of-Network
Basic ServicesPlan Pays 80%
deductible appliesYou Pay: 20%
Plan Pays 55% *deductible applies
You Pay: 45% plus Balance Billing *
Amalgam or composite resin fillings Extractions – surgical/non-surgical Periodontics - non-surgical / surgical treatment of gum disease Endodontics - pulp therapy and root canal filling Repair of implants, dentures and bridgework General Anesthesia - intravenous sedation & general anesthesia Oral Surgery Stainless steel crowns
GSD/RMD Dental ProgramBenefits Overview
* The approved fees applicable to non-participating providers are less than those applicable toPPONew Mexico dentists. Because non-network providers may balance bill patients for amounts above
approved fees, and because these benefit levels are lower than those applicable in-network,out-of-pocket costs may be significantly higher if services are received out-of-network.
Benefit In-Network Out-of-Network
Major ServicesPlan Pays 60%*
deductible appliesYou Pay: 40%*
Plan Pays 35% *deductible applies
You Pay: 65% plus Balance Billing *
Inlays, Onlays, Crowns and Cast Restorations – when teeth cannotbe restored with amalgam or composite resin restorations
Prosthodontics – Bridges, partials or complete dentures
Implants – specified services and related prosthodontics, subject to clinical review/approval
GSD/RMD Dental ProgramBenefits Overview
* The approved fees applicable to non-participating providers are less than those applicable toPPONew Mexico dentists. Because non-network providers may balance bill patients for amounts above
approved fees, and because these benefit levels are lower than those applicable in-network,out-of-pocket costs may be significantly higher if services are received out-of-network.
Benefit In-Network Out-of-NetworkORTHODONTIC SERVICES
No deductibleChildren -- up to 18th birthday
Plan Pays 75% up to a $2000 lifetime maximum
Adults -- age18 and over
Plan Pays 60%up to a $1750 lifetime maximum
GSD/RMD Dental ProgramBenefits Overview
There are Limitations and Exclusions not covered in this Benefits Overview.Refer to the Dental Benefit Handbook for complete coverage information.
Patient Disclosure –You’re entitled to it!
PPONEW MEXICO Dentist’s Guarantee
Upon request, a pre-treatment cost range will be provided by your dentist
Pre-determination of benefitsis available from Delta Dental - recommended (not required) for expensive procedures
You and your dentist agree
GSD/RMD Dental PlanPatient Disclosure
GSD/RMD Dental Plan
Verify eligibility Review benefit information Review Calendar Year
Maximum and Deductible Information
Check on a specific claim Print a personalized ID card Review oral health information
24/7 Information Access with the Delta Dental Online Consumer Toolkit!
deltadentalnm.com
GSD/RMD Dental Plan
All dental plan claims and administration services provided in New Mexico
Trained Benefit Representatives
• Available Monday – Friday 8:00am-4:30pm
• Albuquerque 505-855-7111
• Toll free 1-877-395-9420
• Over 95% of calls answeredin fewer than 45 seconds
GSD/RMD Dental Plan
Questions?