Dental Plan
Please click here for 2006-2007 Dental Rates
General Description of Coverage
Dental coverage
is available to all individuals who are eligible for health benefits with
the University.
You may be enrolled in one of the three dental plans.
Dental Benefit Providers DHMO, United Concordia DHMO, or United Concordia
DPPO.
NOTE: You cannot withdraw from the
plan during the plan year if your selected dentist decides not to participate
with the plan. Dentists can elect not to participate at
anytime.
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Dental Health
Maintenance
Organization (DHMO) |
Dental
Preferred Provider Organization
(PPO) |
How the DHMO
Plans Work
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How the PPO
Program Works |
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The DHMO plan offers each family member the option of
selecting a different Primary Dental Office from the dental
network, which will provide, or arrange for, all of their dental
care. Preventive and diagnostic dental care is covered in full,
while restorative and other major services are offered at a reduced
cost. Orthodontic services are available for both adults and
children (call the dental plans for details and limitations). There
are no claim forms and you are only responsible for copayment amounts
which are part of the program design. There are no deductibles and
no yearly benefit maximums. A referral is required in order to see
a specialist.
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The Dental PPO plan is available
through United Concordia.
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Members may utilize participating and/or non-participating providers.
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There is a deductible of $50 per person/$150 per
family per calendar year (excluding Class I Diagnostic and Preventive
Services and Class
IV Orthodontic Services).
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There is a maximum benefit of $1,500 per member per calendar year
for services received under the PPO plan.
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When care is received from a participating network
dentist, there are no claim forms to submit and you are only responsible
for coinsurance
amounts. If you receive services from a non-participating provider,
claims forms must be submitted and you are subject to balance billing.
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You do not need a referral to receive care from a specialist.
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Orthodontic benefits are available for dependent children. The orthodontia
lifetime maximum is $2,000. Orthodontic services are available from
participating and non-participating providers.
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If you reside in an area that does not have a United
Concordia network of DHMO dentists, you must select the PPO plan
in order to receive
dental benefits from United Concordia.
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Copayments:
All
preventive and routine diagnostic services are covered at 100% when
services are received from the primary dental office. Review
the Schedule of Benefits for each plan for the copayment amounts
associated with each type of dental service. |
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Schedule of Benefits:
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Predetermination of
Benefits:
There is no general requirement for you or your
primary dentist to seek predetermination of benefits before
treatment starts, except for specified services under the POs
OPTION; however, you are encouraged to do so for major dental
procedures so that you and your dentist will know exactly what will
be covered and what your financial liability will
be. |
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Out-of-Area
Emergencies
Your selected dental plans will pay
up to a maximum of $50, subject to your copayment, for emergency
dental services when you are traveling out of the area(more than 50
miles from your dentist's office). In order to receive payment
for out-of-area emergency care, you must submit a receipted bill
itemizing the charges and services performed. This claim
should then be forwarded to your dental plan for processing.
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Advantages of the DHMO |
When care is received
in-network, the benefits are:
- No claim forms
- No deductibles
- No charge for Preventive and
Diagnostic Services
- No pre-existing condition exclusion,
except for orthodontics in progress
- Braces are covered for children and
adults
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Things to
Remember |
- You, or a family member, can charge
your primary dentist at any time (if no balance exists)
- You can choose a different dentist for
each family member
- Copayments are the same, regardless of
whether care is rendered by a participating general dentist or a
specialist
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DHMO only |
- You must obtain a referral from your primary care dental
site to see a specialist
- Claim submission is necessary for out-of-area emergency
care
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How to Receive Dental Plan
Benefits (DHMO)
You must select a Primary Dental Office (PDO) from
your selected dental plan's network of participating dentists when you
enroll. You may obtain a Primary Dental Office Selection Form from the
Office of Employee Benefits or by calling the dental plan. If you do not make a
selection prior to the start of the plan year, you will be assigned a dentist
closest to your zip code. You are free to change your primary provider
site selection at any time. Remember to verify provider participation
before seeking care by calling your dental plan. Before you receive any
services, be sure to contact your dental plan to ensure that you know all
out-of-pocket costs and liabilities associated with a particular type of
treatment.
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