state of colorado open enrollment 2015-2016, effective july 1

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State of Colorado Open Enrollment 2015-2016, Effective July 1

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Page 1: State of Colorado Open Enrollment 2015-2016, Effective July 1

State of Colorado Open Enrollment 2015-2016, Effective July 1

Page 2: State of Colorado Open Enrollment 2015-2016, Effective July 1

Covering Colorado smiles for more than 57 Years.

Page 3: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 4: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 5: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 6: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 7: State of Colorado Open Enrollment 2015-2016, Effective July 1

• Visit our website• Call customer service• Use the mobile app

Finding a dentist is easy.

Page 8: State of Colorado Open Enrollment 2015-2016, Effective July 1

NETWORK UTILIZATION

PPOPremierNon-Par

You save the most money when you see a PPO dentist.

Page 9: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 10: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 11: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 12: State of Colorado Open Enrollment 2015-2016, Effective July 1

Dependents under age 5 are covered at

no cost to you.

Page 13: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 14: State of Colorado Open Enrollment 2015-2016, Effective July 1

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.

Page 15: State of Colorado Open Enrollment 2015-2016, Effective July 1

PREVENTION FIRST

Page 16: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 17: State of Colorado Open Enrollment 2015-2016, Effective July 1

EYEMED

Don’t forget that you have a discount vision plan, included at no additional cost.

Page 18: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 19: State of Colorado Open Enrollment 2015-2016, Effective July 1

A website built with you in mind.

• Cost Estimator• Risk Assessment Tool• Benefits and Claims

Updates• Oral Health Flyers

www.deltadentalco.com

Page 20: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 21: State of Colorado Open Enrollment 2015-2016, Effective July 1

MOBILE APPWhen you need info on the go

Find a dentist

View benefits and claims

Mobile ID card

Toothbrush timer

1

2

3

4

Page 22: State of Colorado Open Enrollment 2015-2016, Effective July 1

TODAY’S DISCUSSION

Network Highlights and Utilization

2015 PlanDesigns

Importance of Prevention

Online Tools

Eyemed Customer Service

Page 23: State of Colorado Open Enrollment 2015-2016, Effective July 1

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

Page 24: State of Colorado Open Enrollment 2015-2016, Effective July 1

We are the champion of your smile.