Fairleigh Dickinson University Webinar Effective Date – January 1, 2010.
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Fairleigh Dickinson University Webinar Effective Date – January 1, 2010
1 Mercer Who is Delta Dental? Largest & most experienced provider of group dental benefits nationally – Over 88,000 client groups now under contract – 54 million members covered – One out of every four dental claims is paid by Delta Dental Delta Dental of New Jersey is not-for-profit dental service corporation with 35 + years
2 Mercer Dental Plan Delta Dental PPO plus Premier – Complete freedom of choice – Access to two national networks – Lower out-of-pocket expenses and no claim forms when using participating dentists – Can access dentists who either participate in the Delta Dental networks or use a non-network dentist
3 Mercer Delta Dental of NJ Dental PPO Plus Premier Preventive & Diagnostic services are covered at 100% (no deductible) Save more on covered services when you visit an in-network dentist No referrals necessary for specialty care For your convenience, ID Cards will be issued. They are not required to receive care. ID cards will be received by mid January.
4 Mercer Delta Dental Plan Comparison Delta Dental Premier® Over 196,000 dental offices nationwide (3 out of 4 licensed dentists)* New Jersey: 8,075 Dental Offices Average 5%-10% discount from billed charges No balance billing in-network above your coinsurance Out-of-network benefits Balance Billing may occur when out of network providers are utilized Delta Dental PPO 116,000 dentists nationally * New Jersey: 4,967 Dental Offices Deep discounted PPO network Average 20% to 25% discount off Delta Dental Premier No balance billing in network above your coinsurance *Approximately 9,000 licensed Dental Offices in New Jersey
5 Mercer Delta Dental of NJ PPO plus Premier Benefit In-Network PPO/PremierOut-of-Network Class I (Preventive)100% Class II (Basic)80%* Class III (Major)50%* Class IV (Ortho)50% up to $1,500 IndividualFamily *Annual deductible$50$150 Calendar year maximum$1,500
6 Mercer Delta Dental PPO plus Premier provides greater access to the largest number of network providers. The chart below illustrates how Delta Dental PPO plus Premier works. As always, subscribers can choose any dentists, either in Delta Dental PPO, Delta Dental Premier or a Non-Participating provider. ExampleDelta Dental PPO Dentists Delta Dental Premier Dentists Non-Participating Dentists Dentists Charge for Procedure X$1,000 Sample Plan Payment Allowance$640$800 Copayment Amount50% Delta Dental Payment$320$400 Patient Payment($640-$320= $320)($800-$400= $400)($1,000-$400= $600) Note: These are hypothetical numbers for illustration purposes. Assume no maximum or deductibles applicable. Delta Dental PPO Plus Premier
7 Mercer Enhancements to the Dental Program Access to the largest network of Dental Providers Carryover Maximum Program Full mouth x-rays payable once every 3 years Bitewing X-rays for adults and children payable 2 times per calendar year Cleanings: You are covered for two in a calendar year. They do not need to be six months apart. Implants covered under major services at 50%
8 Mercer Carryover Maximum Allows you to carry over a portion of your unused annual maximum benefit limit into the next year and beyond – You may carry up to 25% of the unused portion up to a maximum of $500 – Example: If you use $200 of your $1,500 Annual Maximum, you can then carry over $325 ($1,300 x 25%= $325) To qualify, you have to receive at least one cleaning or oral exam during the plan year The accumulated amount can never exceed twice your standard annual maximum. ($3,000)
9 Mercer Brush Biopsy Coverage Oral Cancer is rising in women,young people and non-smokers Delta Dental coverage extended in 2005 Benefit provided under Remaining Basic Brush biopsy is a minimally invasive, low-cost product and service that enables the early detection of oral cancer at a stage when it is most easily treated. Helping In The Fight Against Oral Cancer
10 Mercer Transition Of Care Delta Dental pays for services upon their completion. If a procedure was started prior to 1/1/2010 but completed after 1/1/2010 Delta will pay for that procedure. Example: A crown preparation is started on 12/17/09, but not finished/completed until January8,2010. The crown should be submitted to Delta Dental of New Jersey for payment. Orthodontic Services will be paid and pro-rated based upon what has already been paid out by your current carrier. Example: $500.00 has already been paid toward braces from your current carrier. Your orthodontic Lifetime Maximum is $1,500.00-Allowing $1,000.00 to be prorated and paid by Delta Dental of New Jersey. Delta Dental of New Jersey will honor Pre-treatment estimates processed through MetLife.
11 Mercer Website www.deltadentalnj.com www.deltadentalnj.com Find a Participating Dentist Online Capabilities: – Check Claims Status – Check Benefit Design – Check Annual Maximum Status – Check Deductible Status – Print an ID Card
12 Mercer Out of Network If you choose to see a out of network provider the dentist may ask you to complete a claim form. Claim forms are found on our website www.deltadentalnj.com under "forms"www.deltadentalnj.com