BS_DeltaDentalPresentation.ppt
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Transcript of BS_DeltaDentalPresentation.ppt
State of New MexicoGeneral Services Department
Risk Management Division
Administered by Delta Dental of New Mexico
Dental Plan BenefitsEffective July, 2008
PPONew Mexico Delta Dental PPO Find a Dentist
“In-Network” providersin New Mexico
Over 750 dentistlocations statewide
These dentists will not billpatients for any amount
over the Planfee allowables.
“In-Network” providers outside of New Mexico
Nationally, over 105,000 dentist
locationsThese dentists will not billpatients for any amount
over the Planfee allowables.
Whenever possible, usein-network dentists.
On-line dentist searchdeltadentalnm.com
Out-of-network dentists may balance bill patients for amounts over the Plan
fee allowables.
Delta Dental has several dentist networks.
In-Network: PPONew Mexico is exclusively available to NMIBAC enrollees, and is exclusively available in New Mexico.
In-Network: Delta Dental PPO dentists are considered in-network when services are received outside New Mexico.
Out-of-Network: Delta Dental Premier. Balance billing will apply, but will be less than if services were received from a dentist who does not participate in Delta Dental Premier.
Higher levels of benefits and lower out-of-pocket costs ALWAYS apply in-network!
GSD/RMD Dental PlanProvider Network Overview
Calendar Year Deductible
Does not apply to Diagnostic & PreventiveServices or Orthodontic Services
$50 per enrolled person $150 aggregate per family
Calendar Year Maximum
$1750 per enrolled person
GSD/RMD Dental Plan
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
* Out of network dentists may balance bill patients for amounts over Plan fee allowables.
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 PlanBenefits Overview
* Out of network dentists may balance bill patients for amounts over Plan fee allowables.
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 teethcannot be 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 PlanBenefits Overview
* Out of network dentists may balance bill patients for amounts over Plan fee allowables.
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 PlanBenefits Overview
Out of network dentists may balance bill patients for amounts over Plan fee allowables.
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.
You and your dentist agree.
Pre-determination of benefits from Delta Dental is recommended (not required) for expensive procedures.
GSD/RMD Dental PlanPatient Disclosure
GSD/RMD Dental PlanInformation Available 24/7!
Online access to personalized benefit information, oral health information,privacy policies and more. No software to purchase or download required.
Featured Plan Information Available at deltadentalnm.com in the Subscriber Section
Go to Subscriber Materials, then sign in with your group number (8523).View, print, or save coverage documents:
Summary of Benefits
Dental Benefit Handbook
Network Information Page
PPONew Mexico Provider Directory
Consumer Toolkit
Select the Consumer Toolkit link, sign in, and:
• Verify eligibility of subscriber and dependents
Confirm status of deductibles and plan maximums
Review how a specific claim was processed
Print a personalized subscriber ID card
www.deltadentalnm.com
Experienced Benefit Service Representatives
Available Monday – Friday 8:00 AM - 4:30 PM (MST)
505-855-7111 or Toll Free 1-877-395-9420
GSD/RMD Dental PlanCustomer Service
All claims and customer services provided locally.
No frustrating phone “menu of options” from which to choose.
Talk to a local representativewithin 45 seconds of calling!
Great service is our way of saying “Thank you for your enrollment.”
www.deltadentalnm.com