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Delta Dental Plan of Massachusetts Delta Dental PPO Plus Premier
How the Delta Dental PPO Plus Premier Program Works
Members' Rights and Responsibilties
Delta PPO Services
Delta Premier Service
General Information
Maximum Payment
Reminder - Do you participate in a flexible spending plan?
Delta Dental Plan of Massachusetts Delta Dental PPO Plus Premier
January 1, 2009
Dear Member:
The Board of Trustees of the Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund would like to thank all of the members who completed the dental benefit survey in October 2008. The Trustees have taken the survey results under advisement, and are considering the comments and concerns expressed by members.
The Board is continuing to research the feasibility of adding a supplemental dental plan, and will keep you informed of our progress.
Dental Benefit Improvements
With the goal of providing the best possible plan of benefits to you, the Trustees are very pleased to announce the following dental benefit improvements, effective as of January 1, 2009:• A 15% increase in Fund payments for Type II (Basic Restorative) services
Commonly used Type II procedures are fillings, extractions and root canals.• A 15% increase in Fund payments for Type III (Major Restorative) services.
Commonly used Type III procedures are crowns, dentures, implants and bridges.
Updated Dental Schedules
Enclosed are updated schedules for Delta Dental Premier network dentists and for Delta Dental PPO network dentists, effective as of January 1, 2009. Both schedules reflect the 15% increase in Fund payments for Type II (Basic Restorative) services and Type III (Major Restorative) services.The Delta Dental PPO Plus Premier Plan combines two of Delta Dental’s networks of participating providers - the Delta Dental PPO network and the Delta Dental Premier network. When you need dental services, you can select a dentist from either the Delta Dental Premier or the Delta Dental PPO network of providers. Regardless of which network your dentist has joined, the Fund payment will be the same for covered dental services.
Member Co-Payments for the Delta Dental PPO
Delta Dental of Massachusetts notified the Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund that dentists’ reimbursements for the Delta Dental PPO will increase as of January 1, 2009. As a result, member co-payments for many of the dental services covered by the Delta Dental PPO will increase as of that date. Member co-payments are shown in the enclosed Delta Dental PPO schedule.If you have any questions or need any additional information, please contact the NAGE Fund Office at 1-800-641-0700 or 617-773-8947.
Sincerely,
The Board of Trustees
Commonwealth of Massachusetts/NAGE
Health and Welfare Trust Fund
Delta Dental PPO Plus Premier is a comprehensive dental plan offered through Delta Dental Plan of Massachusetts.
How the Delta Dental PPO Plus Premier Program Works
The Delta Dental PPO Plus Premier program combines two of Delta’s national dental networks – Delta PPO and Delta Premier Networks – giving you access to dentist that participate in both. There are many advantages when you use a dentist who participates in the Delta Plan. Plus, if your dentist participates in the Delta PPO network you’ll save even more money because you’ll receive services at a reduced rate lowering your out-of-pocket expense.
When you need dental services, you will be able to select a dentist from either the Delta PPO or the Delta Premier network of dentist. Regardless of which network you select, the Fund payment for covered dental procedures will be the same. However, your out-of-pocket expenses will be different, depending on which network you select.
- The Delta Premier network is a large network of dentist, with approximately 96% of dentist in Massachusetts. Savings are created through Delta-negotiated dentists’ fees.
- The Delta PPO network is a smaller network of dentist who have agreed to fees that are up to 25% -30% less than what dentists normally charge. Approximately 20% of dentist who participate with Delta Premier in Massachusetts also participate with Delta PPO. Most often, the Delta PPO network will result in greater out-of-pocket savings for you, as compared to the Delta Premier network.
- Members or eligible dependents who receive services from a dentist who does not contract with Delta Dental will still be eligible for coverage, but without the benefit of the Delta discount. You will be balanced billed for the difference between the dentist’s charge and the maximum payment allowed by the Fund.
To verify if your dentist is part of the Delta PPO Plus Premier, refer to the Directory of Participating Providers available thorough Delta Dental or Delta Dental’s website www.deltadentalma.com. You can also call Delta Dental Customer Service department at (800) 872-0500. When choosing a participating provider, keep in mind that the deepest discounts will be received with a Delta PPO provider.
The 2008 dental schedules can be viewed below, the Delta PPO schedule and the Delta Premier schedule. The Delta PPO schedule lists the dental services covered by this plan and the members’ co-payments for those services if received from a participating dentist. The Delta Premier schedule lists the covered dental service and the Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund maximum payment for those services.
The maximum payment each calendar year is $1,051.25 for each insured person, excluding orthodontia.
MEMBERS' RIGHTS AND RESPONSIBILITIES
AS A DELTA MEMBER, YOU HAVE THE RIGHT TO:
- file a grievance about Delta Dental Plan or the participating providers
- be provided with appropriate information about Delta and its benefits, providers and policies
- be informed of your diagnosis, treatment and prognosis by your dentist
- give informed consent before beginning any dental treatment, and be made aware of consequences of
refusing treatment
- obtain a copy of your dental record, in accordance with the law
- be treated with respect and recognition of your dignity and need for privacy
YOU HAVE THE RESPONSIBILITY TO:
- ask questions in order to understand your dental condition and treatment, and follow instructions for recommended treatment given by your dentist
- provide information to your dentist that is necessary to render care to you
- be familiar with Delta benefits, policies and procedures, by reading the materials or calling customer service
Delta PPO ServicesThe following schedule lists the dental services covered by this plan and the members’ co-payments for those services if received from a Delta PPO dentist. The member’s co-payments are effective January 1, 2009.
The following schedule lists the dental services and the Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund maximum payment for those services. This schedule if effective January 1, 2009.
Download Delta Premier Schedule
MAXIMUM PAYMENT
The Maximum Payment of $1051.25 for each calendar year for each insured person excludes orthodontia. Any services provided after the $1051.25 maximum has been met are the responsibility of the member. For services provided after the $1051.25 maximum, the Delta PPO dentist may charge regular and customary fees that are your responsibility. However, you can ask your dentist to provide services at a discounted rate even after the $1051.25 maximum has been reached. It is worth asking to see if your dentist is willing to do so.DO YOU PARTICIPATE IN A FLEXIBLE SPENDING PLAN?
A Flexible Spending Plan is a program that allows you to have a designated dollar amount of your paycheck put aside and held in an account until you need to use it for out-of-pocket healthcare expenses. The money is deducted before taxes are paid, allowing you to apply 100 percent of the money you earn and put aside toward eligible expenses.
The out-of-pocket cost for dental benefits not covered by your dental plan including crowns, endodontic service, implants, oral surgery, periodontal services, sealants and orthodontia are eligible expenses under a Flexible Spending Plan. For additional information call The Group Insurance Commission Health Care Spending Account Administrator at 1-866-862-2422 or visit the Group Insurance Commission web site at the link below.