Delta Dental Plan

All Direct Bill members enrolled in health coverage are also enrolled in the dental plan, unless the member has opted out of the dental plan. For those members that continue with the dental plan, you may also choose to purchase dental coverage for your dependents that are enrolled in the health plan. You have access to two provider networks and are free to use both Delta Dental Networks.

Important Note: Members may elect to opt out of Delta Dental coverage; however, once a member opts out, the member will not be able to re-enroll in dental coverage at a later date.

Delta Dental Premier Network

The Delta Dental Premier Network is the broad network of providers that you may use. Delta Dental will make payment directly to the dental provider. You will be responsible only for paying the specific coinsurance and deductibles for covered services in addition to any services not covered. Delta Premier Dentist agree to accept the plan allowance as payment in full.

Delta Dental PPO Network

Delta Dental also offers the Delta Dental PPO network. The PPO network providers have agreed to a reduced fee for providing dental services. As a result, you generally pay a lower percentage of the total bill than you would when using the Premier Network. The PPO network for our group includes all PPO providers in the national DeltaUSA PPO network. Again, all participants in the Delta Dental program may use the PPO providers whenever desired.

Preventive Care

Diagnostic and preventative services are covered at 100% with no deductible. Covered services include:

• Prophylaxis/cleanings - twice per plan year.
• Oral examinations - twice per plan year.
• Bitewing x-rays
  • adults - 1x a year
  • children under 18 - 2 x a year
• Full mouth x-rays - once each five (5) years.
• Limited coverage for children only:
  • Sealants
  • Space maintainers
  • Topical fluoride
• Ancillary - emergency relief of pain.

Plan Deductibles

A deductible of $50 per person with a maximum annual family deductible of $150 now applies to all basic and major restorative care. This includes:

Basic Restorative

• Regular restorative dentistry - fillings
• Oral surgery
• Endodontics - root canals
• Periodontics - treatment of gum and bone disease
• Additional diagnostic X-rays

Major Restorative

• Special restorative dentistry - crowns
• Prosthodontics - bridges, implants and dentures
• TMJ Treatment - requires prior authorization

A $1,000 per person per lifetime benefit applies to orthodontic benefits; and there is an annual benefit maximum of $1,700 per person per year for all dental services except orthodontics.

Coinsurance

Preventive Care Services are always covered at 100 percent of the allowed amount. Ninety days after a preventive office visit or cleaning, the member is eligible for the enhanced benefit. The basic benefit applies when the member has not had at least one routine prophylaxis (cleaning) and/or preventive oral exam in the prior 12 months. The member is responsible for paying 50% coinsurance for all basic and major restorative services, regardless of provider.

However, if the member has had at least one routine prophylaxis (cleaning) and/or preventive oral exam in the preceding 12 months, basic restorative services are subject to a coinsurance of 20% when provided by a PPO provider and 40% coinsurance when provided by a Premier or Non Network provider. Major restorative service continue to be covered at the 50% coinsurance rate for all providers.

New Direct Bill members will have a one year grace period at the enhanced level to get their annual exam and cleaning.

For more details on Delta Dental Benefits, go to www.khpa.ks.gov and click on the 2010 Open Enrollment button, then select Dental Coverage or call Delta Dental at 1-800-234-3375.

Click here for provider contact information and more.

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