Overview of Dental Benefits by Delta Dental of California – Salinas Education Center Certificated

Overview of

Dental Benefits

by Delta Dental of California –

Salinas Education Center Certificated

Monterey Bay Public Employees TrustOverview of Dental Benefits (Delta

Dental)Salinas Education Center Salinas Education Center

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No I.D. Cards. No claim forms.

• Locate a Delta dentist by visiting deltadentalca.org or calling 1-800-427-3237.

• Make an appointment and tell the dentist you are a Delta member.

• Bring the name of your employer (Salinas Union H.S. District) and Group Number (1317-0005) with you.

Monterey Bay Public Employees TrustOverview of Dental Benefits (Delta

Dental)Salinas Education Center Salinas Education Center

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You can keep your dental expenses down by:• Comparing the fees of different dentists;

• Using a Delta dentist;

• Having your dentist obtain predetermination from Delta for any treatment over $300.00;

• Visiting your dentist regularly for checkups;

• Following your dentist’s advice about regular brushing and flossing;

• Avoiding putting off treatment until you have a major problem.

Monterey Bay Public Employees Trust

Overview of Dental Benefits (Delta Dental)

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Calendar Year Benefit Maximums

• Diagnostic, Preventive, Basic, Restorative, and Prosthodontic: $1,000.00 for each enrollee.

• Dental Accident: $1,000.00 for each enrollee; this Benefit is separate from the other Benefits.

Lifetime Benefit Maximums

• Orthodontic: None.




Increasing Benefits Program

• Delta will pay 70% of the Covered Fees for the Diagnostic, Preventive, Basic, Crown, and Restorative Benefits during the first (1st) year of eligibility;

• This percentage increases 10% each consecutive year the dentist is visited to a maximum of 100%;

• If you don’t visit your dentist in any calendar year, the percentage remains at the level you reached the previous year;

• If you reestablish eligibility after losing it, the percentage returns to 70%.

Monterey Bay Public Employees TrustOverview of Dental Benefits (Delta Dental)Salinas Education Center CertificatedSalinas Education Center Certificated

Diagnostic Benefits (70%-100%)

• Oral examinations (maximum of two (2) in any calendar year); x-rays (once every three (3) years; bitewing x-rays once in any calendar year to adults- two (2) times a year to children); diagnostic casts; examination of biopsied tissue; palliative (emergency) treatment of dental pain; specialist consultation.


Preventative Benefits (70%-100%)

• Prophylaxis (cleaning); fluoride treatment; space maintainers.


Basic Benefits (70%-100%) (slide 1 of 5)

• Oral Surgery: extractions and certain other surgical procedures, including pre- and post-operative care;



• Restorative: amalgam, silicate, or composite (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay);



• Endodontic: treatment of the tooth pulp;

• Periodontic: treatment of gums and bones that support the teeth;





• Sealants: topically applied acrylic, plastic, or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay (limited to eligible dependent children under the age of fourteen(14)) not including the repair or replacement of a sealant on a tooth within three (3) years of its application;



• Adjunctive General Services: general anesthesia; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post-surgical complications (unusual circumstances); limited occlusal adjustment.


Crowns, Jackets, Inlays, Onlays, and Cast Restoration Benefits (70%-100%)

• Benefits only if they are provided to treat cavities which cannot be restored with amalgam, silicate, or direct composite limited to once every five years on the same tooth unless replacement is required because the restoration is unsatisfactory due to poor quality of care or extensive loss of tooth structure or supporting tissue since the replacement of the restoration.


Prosthodontic Benefits

• Construction or repair of fixed bridges, partial dentures, and complete dentures if provided to replace missing, natural teeth once every five (5) years unless there has been such an extensive loss of remaining teeth or a change in supporting tissue that the existing appliance cannot be made satisfactory. (Paid at 50% every year with no increasing annual level of benefit.)


Orthodontic Benefits

• None.


Dental Accident Benefits

• Any services which would be covered under other Benefit categories when they are provided for conditions caused directly by external, violent, or accidental means. (Paid at 100% every year with an annual maximum of $1,000.00.)


Rates (effective 4/01/2014)

• $77.93 per month (composite rate – same rate for Single, Single +1, or Full Family).




Disclaimer

• This presentation provides only a general overview of your Dental benefits;

• For complete information, consult your copy of the Combined Evidence of Coverage and Disclosure Form or contact either Delta Dental (1-800-427-3237 or www.deltadentalca.org) or Health Services & Benefit Administrators (1-831-757-1711 or 1-888-742-3380).

Documents

Overview of Dental Benefits by Delta Dental of California – Salinas Education Center Certificated