state of colorado open enrollment 2015-2016, effective july 1
TRANSCRIPT
State of Colorado Open Enrollment 2015-2016, Effective July 1
Covering Colorado smiles for more than 57 Years.
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
Premier®
PPOSM
We have 3,175 Premier providers and 2,097 PPO
providers in Colorado.
92% of all Colorado dentists are in our
network… and we’re growing!
TWO NETWORKS WORKING TOGETHER
Porcelain Crown Delta Dental
PPOSM
Delta Dental Premier®
Non-Participating
Average Submitted Charge $1,297.07 $1,297.07 $1,297.07
DDCO Contracted Allowance $815.00 $1,090.00 $815.00 *
Member Co-Share 50% 50% 50%
Balance Billed to Member (Submitted vs. Contracted fee)
$0.00 $0.00 $482.07
Total Member Cost(Balance Billed + Co-Share)
$407.50 $545.00 $889.57
* No Contract Exists for Non-Par Dentists
BEST VALUE FOR MEMBERSOur deeper discounts help you save on out-of-pocket costs
• Visit our website• Call customer service• Use the mobile app
Finding a dentist is easy.
NETWORK UTILIZATION
PPOPremierNon-Par
You save the most money when you see a PPO dentist.
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
Services PPO Dentists Premier DentistsOut-of-Network
Dentists
ReimbursementDDCO pays dentist @ PPO
Allowable Fee
*DDCO pays dentist @ Premier Maximum Plan
Allowance
**DDCO pays dentist @ PPO Allowable Fee. Member
responsible for difference up to billed charge.
Diagnostic &Preventive Services (1)
Basic Services 70% 70%* 70%**
Major Services 50% 50%* 50%**
Orthodontics N/A N/A N/A
Deductible:IndividualFamily
Maximum:
(1) Prevention First
Annual Plan Maximum (1) $1,000
Claims for Diagnostic / Preventive Services do not count towards the annual plan maximum
100% 100%* 100%**
$50 $150
2015 BASIC PLAN
Services PPO Dentists Premier DentistsOut-of-Network
Dentists
ReimbursementDDCO pays dentist @ PPO
Allowable Fee
*DDCO pays dentist @ Premier Maximum Plan
Allowance
**DDCO pays dentist @ PPO Allowable Fee. Member
responsible for difference up to billed charge.
Diagnostic &Preventive Services (1)
Basic Services 80% 80%* 80%**
Major Services 50% 50%* 50%**
Orthodontics 50% 50%* 50%**
Deductible:IndividualFamily Limit
Maximums:Annual Plan Maximum (1)
Lifetime Ortho Max
(1) Prevention FirstClaims for Diagnostic / Preventive Services do not count towards the
annual plan maximum
$2,000 $2,000
100% 100%* 100%**
$50 $150
2015 BASIC PLUS PLAN
Dependents under age 5 are covered at
no cost to you.
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
Did you know?
• 90% of systemic disease have signs and symptoms in and around the mouth.
• Regular dental cleanings can help catch serious diseases like cancer, heart disease, and diabetes.
PREVENTION FIRST
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
EYEMED
Don’t forget that you have a discount vision plan, included at no additional cost.
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
A website built with you in mind.
• Cost Estimator• Risk Assessment Tool• Benefits and Claims
Updates• Oral Health Flyers
www.deltadentalco.com
EMPLOYEE TOOLSThe online portal that makesyour life easier
• View claims and benefits• Electronic EOB• Print an ID card• Oral health and wellness
information• Provider Search
MOBILE APPWhen you need info on the go
Find a dentist
View benefits and claims
Mobile ID card
Toothbrush timer
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TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
LOCAL SERVICEService you need when you need it…because we live where you live
Phone:1-800-610-0201
Email:[email protected]
Hours:Monday – Friday 8 a.m. – 6 p.m.
24/7 Automated Call Center
We are the champion of your smile.