Download Delta Dental Premier - Delta Dental of Minnesota

Delta Dental Premier
®
- Designed for groups of 5-99 eligible employees
- Groups can pay all, some or none of the premium
costs on behalf of employees
Great benefit options, the state’s largest dental network
The Delta Dental Premier program is our original network
plan, featuring access to the state’s largest dental
network – the Delta Dental Premier network.
We offer a plan with preventive-only coverage for
the lowest premium costs; a plan with coverage for
preventive care and some more involved procedures
like fillings, extractions, root canals and periodontal
care; and two comprehensive plan options for groups
that want the strongest coverage including implants,
crowns, bridges, dentures and optional orthodontic
coverage.
See any dentist or specialist
• Receive 100% coverage for preventive care in-network.
• Receive care from any licensed dentist. However,
out-of-pocket costs are greatly reduced when a Delta
Dental Premier network dentist provides services.
We set the standard for service
• We retain 98% of our customers year after year.
• We process the average claim in just over one day. Claim
processing accuracy is almost 100%.
• We’ve received an “A” rating (Excellent) from A.M. Best
for 14 straight years for our financial stability, among the
highest-ranked dental plans in the country.
For more information:
Groups – Contact your broker for a competitive proposal or
contact Delta Dental Connect at 1-800-906-5250 or by e-mail,
[email protected].
Brokers – Generate a proposal in only a few minutes on our
Web site 24/7, or contact Delta Dental Connect for personal
assistance.
Advantages to seeing network dentists include:
No balance billing – With a network dentist, members won’t
be billed for the difference between the actual procedure
charge and what the plan allows. When members receive
care from a non-network dentist, they are responsible for
the balance of the bill.
No paperwork – When members use network dentists, there’s
no paperwork. Dentists bill us, and we pay them directly.
Members choosing a non-network dentist may have to submit
their own claim for covered expenses.
The largest network in the state – and the nation
• More than 80% of Minnesota dentists are part of our Delta
Dental Premier network. No competitor network comes
close to matching the breadth of our network in the state
or across the country.
• Members have automatic emergency dental coverage when
they travel internationally.
Delta Dental of Minnesota • 500 Washington Ave. S., Suite 2060 • Minneapolis, MN 55415
www.deltadentalmn.org
DELTA DENTAL PREMIER PROGRAM
SERVICE
DESCRIPTION
BENEFIT
PREVENTIVE
PLAN
BASIC
PLAN
COMPREHENSIVE PLANS
STANDARD
ENHANCED
100%
100%
80%
100%
Diagnostic and Preventive
Services
Oral evaluations/checkups, x-rays, dental cleanings, fluoride treatments
100%
100%
Other Preventive Services
Space maintainers
100%
100%
N/A
80%
80%
80%
Basic Oral Surgery Services:
Basic extraction of erupted tooth or exposed root
80%
80%
80%
Complex Surgical Extractions:
Surgical removal of erupted tooth, impacted tooth and tooth roots
80%
80%
80%
Other Complex Oral Surgical Procedures:
Alveoloplasty, vestibuloplasty, frenulectomy, tooth reimplantation
80%
N/A
80%
Adjunctive General Services:
Intravenous conscious and IV sedation with complex surgical services
80%
80%
80%
Basic Endodontic Therapy:
Pulpal therapy, root canal therapy, pulpotomy
80%
80%
80%
Complex Endodontic Services:
Hemisection, apicoectomy
80%
N/A
80%
Basic Periodontal Services:
Non-surgical periodontal care
80%
80%
80%
Complex Surgical Periodontal Care:
Surgical periodontal care
80%
80%
80%
Optional
treatment †
Optional
treatment †
Optional
treatment †
50%
Basic Services
Complex or Major
Restorative Services
Basic Restorative Care and Services:
Amalgam (silver) fillings, sealants, palliative treatment for emergencies
Posterior composite resins
N/A
Inlays
N/A
Onlays, crowns and crown repairs
N/A
50%
Optional
treatment †
50%
Restorative cast post and core buildup, including pins and posts for crown
N/A
N/A
50%
N/A
50%(**)
50%
50%(**)
50%
Restorative cast post and core buildup, including pins and posts for bridge
N/A
50%
Repairs - removable and fixed prosthetic services
50%
50%
50%(**)
50%
Prosthetic Services
Removable prosthetic services - dentures and partials
N/A
Fixed prosthetic services - bridges
Implants
Deductible
Per person/per family (calendar year)
No deductible for diagnostic and preventive services
Copayment
Annual Plan Maximum
Per Person/Per Calendar Year
Optional Orthodontic
Coverage
after deductible
None
$25/$75
$25/$75
or
$50/$150
$25/$75
or
$50/$150
$10 per
office
visit
N/A
N/A
N/A
$1000
$1000
$1000
$1000
$1000
or $1500
$1250
5 to 29 enrolled employees
30 or more enrolled employees
A minimum of 10 enrolled employees required
Available only for dependent children, age 8-18
N/A
50%
$1,000 lifetime maximum
Members who receive services from non-Delta Dental network dentists are covered at the same benefit level as those who see Delta Dental Premier network participating dentists.
However, because non-Delta Dental network dentists are not under contractual obligation, they may balance bill members for the amount not reimbursed under the plan.
†Optional Treatment: Plan member receives the amalgam benefit for the least costly, commonly performed course of treatment. The plan member is responsible for the balance
of the treatment cost. ** Missing-tooth exclusion applies during the first 24 months of coverage. Claim payments are subject to review. We strongly recommend a pre-estimate for
implants and all major services. For exact benefits and current rates, contact your Delta Dental Connect Sales Representative: (651) 406-5920 or (800) 906-5250
DDMN.164.13