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Adobe Captivate
Sunday, May 14, 2017
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In this session we will discuss the dental benefits offered through the State Employee Group
Insurance Program (SEGIP).
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Dental coverage is an optional benefit.
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You have an opportunity to decide if you want to enroll you and your eligible dependents.
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With dental insurance you may elect single coverage, family coverage or you may waive
coverage entirely.
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As a newly eligible insurance participant your insurance packet includes a dental plan rate guide
with employee premiums for single and family coverage.
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If you decide to waive dental coverage at the time you are newly eligible, unless you have a
qualified life event, you will have to wait until the next available Open Enrollment.
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Therefore, you may have to wait up to two years. This benefit is only included in the annual
Open Enrollment every other year.
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For more information on qualified life events please review the Your Employee Benefits booklet
or your union contract or plan available on MMB’s website at www.mmb.state.mn.us under the
Insurance & Wellness section located on the left hand side of the page in the gray box
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SEGIP offers a single comprehensive dental plan design administered by two dental carriers.
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As an employee you have the choice to decide on which carrier is right for you.
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The first carrier is Delta Dental. The plan is referred to as the State Dental Plan – Group # 216
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The second carrier is HealthPartners. This plan is referred to as the HealthPartners State of
Minnesota Dental Plan – Group # 3080
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When determining which of the two carriers is best for you, you need to know that the dental
plan design offers in and out of network benefits.
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You have greater coverage when using participating in-network dentists.
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To see if your dentist participates in one of these two networks, visit the Minnesota Management
and Budget website within the Insurance and Wellness section located on the left side of the
page within the gray box.
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Adobe Captivate
Sunday, May 14, 2017
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Likewise, if you do not have a dentist that you already use, you may search the network
database to find a participating in-network dentist.
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Before we explore the details of the dental plan design let's review some key terminology.
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Allowed Amount: The maximum amount of the billed charge an insurance company deems is
payable by the plan for covered services and/or supplies rendered by participating providers and
facilities or by nonparticipating providers and facilities.
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If the charge for the service is greater than the allowed amount, those charges that exceed the
allowed amount are all the responsibility of the employee to pay.
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Simply put, an allowed amount is the amount that the dentist will accept as payment in full. For
example, if you are using an in-network dentist and they normally charge a retail cost of $125 for
a filling, but under our contract the allowed amount is only $100, you will not be billed for the $25
difference.
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Deductible: A set amount that is paid annually before the plan benefits take effect. Once the
deductible is paid, it is not charged again during the calendar year.
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In-Network: Services provided by a dental provider who is participating within the state of MN
carrier network.
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Out-of-Network: Services provided by a dental provider who does not participate within the state
of MN carrier network.
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Pre-Estimate: An estimate of the dental treatment to be preformed; typically occurs after the
inital exam.
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If the necessary dental treatment involves major restorative, periodontics, prosthetics or
orthodontic care, your dentist will submit a request for a pre-estimate of benefits to the dental
carrier of the proposed treatment which will help determine your out of pocket expenses.
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Now that you have found a dentist and selected a carrier, let's move onto how the plan design
works. The annual maximum benefit that you have under this plan each year is $1,000. We will
focus on the in-network benefits first.
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Preventive care is covered at 100% with no deductible.
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When using an in-network dental provider you will have a $50 annual deductible per person and
a $150 annual deductible per family.
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Sunday, May 14, 2017
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Under the in-network dental plan design basic and major restorative services are covered at
60%, after your annual deductible.
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For example, if you need to have a cavity filled the cost to you would be 40% of the negotiated
charges after you have satisfied your $50 annual deductible for the plan year.
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To gain a better understanding of your out-of-pocket expenses, it is recommended that you
obtain a pre-estimate of benefits prior to having services rendered.
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Now let's compare this to how the out-of-network benefits would cover these same services.
Note that these cost sharing benefits are based on allowed amounts.
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Preventive care is covered at 50% and subject to an allowed amount.
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When using an out -of-network dental provider you will have a $125 annual deductible per
person.
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Under the out-of-network dental plan design basic and major restorative services are covered at
50% of the allowed amount after your annual deductible.
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For example, if you need to have a cavity filled, the cost to you would be 50% of the allowed
amount after you have satisfied your $125 annual deductible for the plan year.
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Although it is not required, it is strongly recommended that you obtain a pre-estimate of benefits
prior to using out-of-network services.
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This will ensure that you have a better understanding of what your financial responsibility will be
toward your dental services.
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Included in the SEGIP dental plan design is an orthodontic benefit limited to dependents under
the age of 19.
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Eligible dependents can choose to see a participating provider or an out-of-network provider for
orthodontic treatment.
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The orthodontic benefits are covered at 50%. Please remember that out-of-network benefits are
subject to allowed amounts. The orthodontic benefits have a separate plan lifetime maximum of
$2,400 per individual.
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We hope that you have gained a better understanding of the dental benefit provided through the
State Employee Group Insurance Program (SEGIP).
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Please note that this is a high level overview of your benefits. For complete information please
refer to the Summary Plan Description.
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If you have additional questions, please refer to your newly eligible packet, visit our website
www.mmb.state.mn.us under the Insurance & Wellness section located on the left side of the
page in the gray box, contact us at 651-355-0100, or review your union contract or plan.
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Please take some time to review our other newly eligible insurance presentations available to
you.
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