Download 2017 Dental Plan Comparison

DENTAL PLAN COMPARISON
FY2018 (July 1, 2017 – June 30, 2018)
BENEFIT
Provider Network
DCP – High
DCP – Basic
DCP – Choice (Out of Area)
Dental Care Plus DHMO
Dental Care Plus DHMO
Balance Value Network / DPPO
Network
Network
$50
$150
$50
$150
Network
Out-of-Network
Annual Deductible (Ded)
Single:
Family:
Plan Annual Maximum
Per Covered Member:
Balanced Billing
Preventive Care
Basic Services
Major Services
Orthodontia
Orthodontia Lifetime Maximum
Benefit (up to Age 19)
$50
$150
$1,500
$750
$1,000
(Preventive services apply to Annual Maximum)
(Preventive services apply to Annual Maximum)
(Preventive services apply to Annual Maximum)
No
$0
Ded + 20%
Ded + 40%
40%
No
$0
Ded + 50%
Ded + 50%
50%
$1,500 per dependent child
$750 per dependent child
No
$0
Ded + 20%
Ded + 40%
40%
Yes
$0
Ded + 20%
Ded + 40%
40%
$1,000 per dependent child
DEFINITIONS
Balanced Billing: If you are subject to balanced billing you will be 100%
responsible for any charges considered above reasonable and customary charge
for the service performed.
Basic Benefits: Generally includes services such as fillings (amalgams) and simple
extractions.
Co-Insurance: The portion of charges that you will pay once you have met the
deductible.
Copay: A flat dollar amount that you pay for a service without needing to first
meet a deductible.
Deductible: An amount of money that the member must pay out of pocket
before the plan begins paying for a service.
Home Maintenance Organization (HMO): An HMO is a type of insurance plan
that usually limits the coverage of care to dentists who are contracted with the
carrier, in this case Dental Care Plus. There is no out-of-network coverage with
the High HMO and the Basic HMO plans.
Major Services: Generally includes restorative services such as crowns, bridges,
implants, and dentures.
Plan Annual Maximum: The maximum dollar amount in benefits paid by the plan
per covered member per plan year; includes preventive, basic, and major services
(if covered).
Preferred Provider Organization (PPO): A PPO is a type of insurance plan that
generally offers in-network and out of network coverage. However, if you do not
use an in network or participating provider, you may be subject to balance billing.
 Note – the Choice (Out of Area) Balance Value is a narrower network in
the Greater Cincinnati area compared to the DCP High/Basic DHMO
network. Please verify if your Dentist is in the BVN network.
Preventive Care: Generally includes two oral exams, two cleanings, and two
bitewing x-rays per 12 month period.
Reasonable and Customary: The reasonable and customary charge for a service
is based upon the usual fee charged for the service by most dentists in a
geographic area.
This document is intended to provide an overview of common services only. Please refer to the applicable Summary Plan Description on CenterLink for more
detailed coverage information.