Dental Product Guide
Dental Product Guide
Dental insurance for employers with 2 to 49 enrollees
2 |Page 3 |Page
For 2012, Delta Dental has turned its small-group product line upside down. We’ve not only enhanced our products; we’ve changed the way we promote them and communicate them to employees. In fact, we’ve changed just about everything except the great Delta Dental service that comes with every plan we sell.
Here are some of the things we’ve changed for 2012:
• Money-saving MAC (Maximum Allowable Charge) options for our most
popular plans
• A new table-of-allowances plan
• Voluntary versions of our popular 2-4-enrolled contributory products • A greater emphasis on increasing enrollment, with new employee-facing
materials and enrollment strategies
• A new website, set to launch in late 2012 • An improved online quoting tool
• New collateral materials
Our small-group plans are backed by our strongest commitment ever to this crucial
market segment. And it’s the foundation for even greater things to come.
Dave Peterson
Vice President, Sales and Marketing
— and learn how their dedication and expertise have made
Delta Dental Wisconsin’s No. 1 choice for dental benefits.
experience.deltadentalwi.com
SHOWN AT LEFT (front to back): David Peterson (Vice President, Sales and Marketing), Tom Williams (Sales, Northern and Western WI), Tracy Thiel (Account Management, Milwaukee and Southeastern WI), Lynn Horn (Account Management, Milwaukee and Southeastern WI), Jackie Bloomer (Sales, Fox Valley, Madison, Milwaukee and Southeastern WI), Michelle Czaplinski (Underwriting), Rick Zupan (Manager, Sales, Statewide), Michele Knoll (Account Management, Northern and Western WI), Scott Meyer (Actuary), Jenny Wydeven (Account Management, Madison), Denny Peterson (Executive Vice President)
SMALL-GROUP TEAM NOT SHOWN: Becki Giese (Account Management, Fox Valley), Andy Wavrunek (Sales Support, Statewide), Megan Wolff (Sales Support, Statewide)
Meet the people of
Delta Dental of Wisconsin
Relax, we’ve got you covered.
Relax, we’ve got you covered.
4 |Page 5 |Page
Our commitment to employers includes...
Networks:ours are bigger.
The Delta Dental PPO has the most verified locations of any Wisconsin
PPO network, and the Delta Dental Premier network is the state’s
largest dentist network. They worked
together to save Wisconsin groups more than $56 million in 2011.
service:ours is better.
Agents, employers, members, and
dentists agree: Delta Dental has the best service of any Wisconsin
dental-benefits provider. In our
latest survey, Delta Dental’s
satisfaction rate topped 94 percent! Delta Dental answers the phone
quickly, provides expert assistance,
and resolves most claim issues with just one call.
kNowledge:we kNow
what you waNt.
We only do business in Wisconsin, with Wisconsin-based employers. We understand the market and the competition and the plans and the
people. Our products reflect that knowledge. They’re created specifically for you and your
business, serviced by Wisconsin people, using a network made in Wisconsin.
expertise:we have more.
Delta Dental started providing
dental benefits in Wisconsin 50
years ago. No one knows more
ways to make dental benefits work
harder for you.
philaNthropy:we take
care of wiscoNsiN.
Delta Dental’s mission is to improve
access to quality oral healthcare
for all Wisconsin residents. Do any other dental-insurance companies have a mission like that?
research:we support it,
aNd we put it to work.
Delta Dental supports ground-breaking oral-health research in Wisconsin and around the world. We’re already looking at the future
of dental benefits, and we’re going
to lead the way.
6 |Page 7 |Page 61% 2% 25% 12% $50 $25 $0 Other 58% 6% 9% 20% 6% 1% $1,200 $1,500 $2,000 Other $1,000 $750 85% 10% 1% 4% 80% 90% 100% Other 81% 9% 2% 4% 60% 80% 100% Other 50% 4%
Plan design:
61% choose a $50 deductible.Annual maximum:
58% choose a $1,000 annual maximum.
Basic services:
85% choose an 80% copay in-network; (78% choose an 80% copay out-of-network.)
Major services:
81% choose a 50% copay in-network; (74% choose a 50% copay out-of-network.)
Setting a dental insurance rate requires that many factors be weighed. Everything has to be in balance,
or the end result could be disastrous.
Delta Dental weighs many factors when setting its small-group rates – overall experience, dentist discounts, type of business, single-family mix, and many more. One of the most important group-
specific factors used in small-group rating is
employee participation.
The greater the percentage of people in a group
enrolling in the dental plan, the more the risk is spread and the lower the rate.
Delta Dental’s best rates are reserved for its highest-participating groups, and that means we may have
to ask you more frequently for participation and contribution information. Great information makes
great rates, and your assistance in gathering this information makes it possible.
Delta Dental has a dedicated worksite-marketing
program to help your organization improve employee
participation. We can help you coordinate effective employee meetings with the tools to get the job done: pre-enrollment materials, employee-facing enrollment materials, easy signup, and a follow-up program.
Making a great rate.
What Wisconsin wants.
What Wisconsin wants is Delta Dental. Our plans have been Wisconsin’s favorites for 50
years. And when it’s time to choose a Delta Dental plan, here’s what Wisconsin groups
just like yours choose.
With this information, you can go along with the crowd or blaze your own trail. Either
way, Delta Dental has you covered.
The answer is balance.
Making a great rate.
What Wisconsin wants.
8 |Page 9 |Page
Delta Dental Table of Allowances Plan
With a Delta Dental Table of Allowances plan, there’s no question what the insurance company pays. The plan schedule lays out what Delta Dental pays for virtually all popular dental procedures.
what is a table-of-allowances plan?
A table-of-allowances plan lists what the plan pays for a given procedure. The more procedures covered, and the more the insurance company pays for a procedure, the better the plan.what are the advantages of a
table-of-allowances plan?
Rates for table-of-allowances plans remain extremely stable over time because the plans aren’t priced by utilization but instead are driven by the composition of the tables. The dollar amounts paid out by the plans don’t change unless the tables change. Because the tables can be set at any amount, the plans can be made to be very affordable at the outset – and stay very affordable over time.
A table-of-allowances plan is great for employers who
want to provide a benefit but feel they can’t afford a
traditional plan, or employers who offer an employee-paid option and feel their employees may struggle to pay the premiums of a traditional plan.
what plans are similarly priced?
For roughly the same price† you can choose:A Delta Dental UltraSavings PPO plan.
(See page 10)
No matter where dental costs go,
Table of Allowances plan rates tend to stay the same.
who is the table of allowances plan for?
Groups looking for immediate and long-term savings. Groups located in areas
where there are a lot of Delta Dental PPO dentists.
Groups where employees pay some or all of the premium.
This plan is
best for:
delta dental table of allowances plan
Delta Dental Table of Allowances Plan
Delta Dental’s most affordable plan.
Note: There is a tradeoff to a table-of-allowances plan: As dental costs go up, your out-of-pocket costs may increase as well. Consider seeing a Delta Dental PPO dentist to minimize the impact of rising dental costs.
Waiting periods also apply for groups with no existing dental plan, and for enrollees who waive coverage initially, drop coverage, or become eligible for the plan after the initial enrollment period (new hires or qualifying events). There is a six-month waiting period for endodontics (root canals), periodontics (gum-disease treatment), extractions, and oral surgery, and a 12-month waiting period for crowns, implants, complete and partial dentures, fixed bridges, and repairs and adjustments. There is no benefit waiting period for diagnostic and preventive services, or basic restorative services. For groups with an existing dental plan, there are no waiting periods for those enrolling during the initial enrollment period.
†As the standard table-of-allowances plan.
A penny saved is a
penny... well, saved!
Member Benefit
Deductible Options – Individual/Family (applies to all procedures) $50/$150
Individual Annual Maximum $1,000
Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays every five years.
One-time application of sealants. Space maintainers as needed.
Plan pays up to the table of allowances amount for specific
services until the annual maximum is reached. See the full
table of allowances for covered procedures and covered amounts.
Basic Restorative Services
Emergency treatment to relieve pain, fillings.
Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), extractions, oral surgery,
crowns, complete and partial dentures, implants, fixed bridges, repairs and adjustments.
Dependent Age Limitation Dependents covered
to age 26
Vision-Care Discount Program Included
10 |Page 11 |Page
A plan that maximizes Delta Dental’s PPO savings.
Delta Dental’s UltraSavings PPO delivers an
affordable-yet-ample benefit for members who see a Delta
Dental PPO dentist from the state’s largest PPO dentist network*.
what is the ultrasavings ppo?
The UltraSavings PPO combines an innovativein-network PPO benefit with an out-of-network benefit that encourages members to see a Delta
Dental PPO dentist, while still covering their basic dental needs.
what else is included?
Each Delta Dental UltraSavings PPO includes:
CheckUp Plus™:
Diagnostic and preventive services don’t count against your annual maximum with CheckUp Plus™.
Evidence-Based Integrated Care Plan (EBICP):
The industry-leading benefit enhancement for
whole-body health, EBICP covers additional cleanings for pregnant women, diabetics, and people with other health conditions. See www.deltadentalwi.com/EBICP for more information.
mac plan option
In addition to your choice of annual maximum and deductible, a MAC (Maximum Allowable Charge) plan option is available, but not required. With a MAC plan, members pay a lower rate, but out-of-pocket expenses can be higher when they see a dentist other than a Delta Dental PPO dentist.
what plans are similarly priced?
For roughly the same price† you can choose:A Delta Dental Table of Allowances plan.
(See page 8)
who is the ultrasavings ppo plan for?
Groups looking for immediate and long-term savings. Groups located in areas
where there are a lot of Delta Dental PPO dentists.
Groups where employees pay some or all of the premium.
This plan is
best for:
delta dental ultrasavings ppo
See a Delta Dental
ppo dentist
Deductible Options – Individual/Family
$25/$75
$50/$150Individual Annual Maximum
The UltraSavings PPO includes CheckUp Plus™. With CheckUp Plus™, benefits paid for diagnostic and
preventive services do not apply to the individual annual maximum.
$1,000
$750Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays every five years. One-time
application of sealants. Space maintainers as needed.
100%
80%*Basic Restorative Services – Type 1
Emergency treatment to relieve pain, fillings.
80%*
50%*Basic Restorative Services – Type 2
Simple extractions.
50%*
40%*Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), oral surgery, crowns, complete and partial dentures, implants, fixed bridges, repairs and adjustments.
50%*
40%*Orthodontic Services (Optional)
If the group has 10 or more enrolled employees, it may
choose to include orthodontic coverage. Coverage applies
for dependent children to age 19. Orthodontic coverage is not available for groups under 10.
50%*
50%*Lifetime Orthodontic Maximum
$1,000
$750Evidence-Based Integrated Care Plan (EBICP)
Delta Dental's Evidence-Based Integrated Care Plan provides expanded benefits for persons with diseases and medical conditions that have oral-health implications. These benefits address the unique oral-health challenges faced
by persons with these conditions, and can play an important role in the management of an individual's medical condition.
Included
IncludedDependent Age Limitation
Dependents covered to age 26, except as noted
for orthodontics
Dependents covered to age 26, except as noted
for orthodontics
Vision-Care Discount Program Included
See page 20 for details.
Included
Included
*Deductible applies.
Delta Dental UltraSavings PPO
Delta Dental UltraSavings PPO
*Delta Dental PPO network measured by locations. | †As the standard UltraSavings PPO plan.
PPO savings really
stack up!
See a Delta Dental Premier or Any Other
12 |Page 13 |Page
The Delta Dental Savings PPO leverages the power of the state’s largest dental PPO network*, combining
a full in-network benefit with cost savings and
treatment guarantees if you see one of the 90 percent of state dentists in the Delta Dental Premier network.
what is a savings ppo?
A savings PPO offers an in-network benefit that’s better than the out-of-network benefit, encouraging
you to see a Delta Dental PPO dentist.
what else is included?
Each Delta Dental Savings PPO includes:
CheckUp Plus™:
Diagnostic and preventive services don’t count against your annual maximum with CheckUp Plus™.
Evidence-Based Integrated Care Plan (EBICP):
The industry-leading benefit enhancement for
whole-body health, EBICP covers additional cleanings for pregnant women, diabetics, and people with other health conditions. See www.deltadentalwi.com/EBICP for more information.
mac plan option
In addition to your choice of annual maximum and deductible, a MAC (Maximum Allowable Charge) plan option is available, but not required. With a MAC plan, members pay a lower rate, but out-of-pocket expenses can be higher when they see a dentist other than a Delta Dental PPO dentist.
what plans are similarly priced?
For roughly the same price† you can choose:A Delta Dental Passive PPO with a lower annual maximum and/or a higher deductible.
(See page 14)
who is the savings ppo plan for?
Groups looking for immediate and long-term savings. Groups located in areas
where there are a lot of Delta Dental PPO dentists.
Groups where employees pay some or all of the premium. This plan is best for: *Deductible applies.
See a Delta Dental
ppo dentist
See a Delta Dental Premier or Any Other
Dentist
Deductible Options – Individual/Family
$25/$75
$50/$150
$75/$225
$25/$75 $50/$150 $75/$225Individual Annual Maximum
The Savings PPO includes CheckUp Plus™. With CheckUp Plus™, benefits paid for diagnostic and preventive services
do not apply to the individual annual maximum.
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays once every five years. One-time
application of sealants. Space maintainers as needed.
100%
100%Basic Restorative Services
Emergency treatment to relieve pain, fillings; simple
extractions.
80%*
60%*Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), oral surgery, crowns, complete and partial dentures, implants, fixed bridges, repairs and adjustments.
Note: Groups may upgrade oral surgery, endodontic and periodontic coverage to the basic-restorative-services level.
50%*
50%*Orthodontic Services (Optional)
If the group has 10 or more enrolled employees, it may
choose to include orthodontic coverage. Coverage applies
for dependent children to age 19. Orthodontic coverage is not available for groups under 10.
50%*
50%*Lifetime Orthodontic Maximum
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Evidence-Based Integrated Care Plan (EBICP)
Delta Dental's Evidence-Based Integrated Care Plan provides expanded benefits for persons with diseases
and medical conditions that have oral-health implications.
These benefits address the unique oral-health challenges
faced by persons with these conditions, and can play an important role in the management of an individual's medical condition.
Included
IncludedDependent Age Limitation
Dependents covered to age 26, except as noted
for orthodontics
Dependents covered to age 26, except as noted
for orthodontics
Vision-Care Discount Program Included
See page 20 for details.
Included
Includeddelta dental savings ppo
Delta Dental Savings PPO
An affordable plan that leverages Delta Dental’s huge PPO network.
Delta Dental Savings PPO
*Delta Dental PPO network measured by locations. | †As a standard $1,000 annual maximum, $50 deductible plan.
Some plans are a dime
a dozen... not ours!
14 |Page 15 |Page
Delta Dental Passive PPO
Delta Dental’s Premier Plus PPO is the only passive PPO available in Wisconsin that combines the state’s largest dentist network* with cost savings and
treatment guarantees if you see one of the 90% of state dentists in the Delta Dental Premier network.
what is a passive ppo?
A passive PPO offers the same annual maximum, deductibles and coinsurance whether you see a Delta Dental PPO dentist, a Delta Dental Premier dentist, or a non-network dentist.
what else is included?
Each Delta Dental Passive PPO includes:
CheckUp Plus™:
Diagnostic and preventive services don’t count against your annual maximum with CheckUp Plus™.
Evidence-Based Integrated Care Plan (EBICP):
The industry-leading benefit enhancement for
whole-body health, EBICP covers additional cleanings for pregnant women, diabetics, and people with other health conditions. See www.deltadentalwi.com/EBICP for more information.
mac plan option
In addition to your choice of annual maximum and deductible, a MAC (Maximum Allowable Charge) plan option is available, but not required. With a MAC plan, members pay a lower rate, but out-of-pocket expenses can be higher when they see a dentist other than a Delta Dental PPO dentist.
what plans are similarly priced?
For roughly the same price† you can choose:A Delta Dental Savings PPO with a higher annual maximum and/or a lower deductible (See page 12); or A Delta Dental Enhanced PPO with a lower annual maximum and/or a higher deductible. (See page 16)
who is the passive ppo plan for?
Groups looking to maximize dentist choice without penalties for seeing out-of-network dentists.
Groups located in areas where there are not a lot of Delta Dental PPO dentists.
Groups with employees scattered around the state or country. This plan is best for: *Deductible applies.
delta dental premier plus ppo
(Passive PPO)
See a Delta Dental Premier or Any Other
Dentist
Deductible Options – Individual/Family
$25/$75
$50/$150
$75/$225
$25/$75 $50/$150 $75/$225Individual Annual Maximum
The Passive PPO includes CheckUp Plus™. With CheckUp Plus™, benefits paid for diagnostic and preventive services
do not apply to the individual annual maximum.
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays once every five years. One-time
application of sealants. Space maintainers as needed.
100%
100%Basic Restorative Services
Emergency treatment to relieve pain, fillings; simple
extractions.
80%*
80%*Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), oral surgery, crowns, complete and partial dentures, implants, fixed bridges, repairs and adjustments.
Note: Groups may upgrade oral surgery, endodontic and periodontic coverage to the basic-restorative-services level.
50%*
50%*Orthodontic Services (Optional)
If the group has 10 or more enrolled employees, it may
choose to include orthodontic coverage. Coverage applies
for dependent children to age 19. Orthodontic coverage is not available for groups under 10.
50%*
50%*Lifetime Orthodontic Maximum
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Evidence-Based Integrated Care Plan (EBICP)
Delta Dental's Evidence-Based Integrated Care Plan provides expanded benefits for persons with diseases
and medical conditions that have oral-health implications.
These benefits address the unique oral-health challenges
faced by persons with these conditions, and can play an important role in the management of an individual's medical condition.
Included
IncludedDependent Age Limitation
Dependents covered to age 26, except as noted
for orthodontics
Dependents covered to age 26, except as noted
for orthodontics
Vision-Care Discount Program Included
See page 20 for details.
Included
IncludedDelta Dental Passive PPO
The gold standard of small-group plans.
See a Delta Dental
ppo dentist
*Delta Dental PPO network measured by locations. | †As a standard $1,000 annual maximum, $50 deductible plan.
Worth its weight
in gold! Our most
16 |Page 17 |Page
Delta Dental Enhanced PPO
who is the enhanced ppo plan for?
Groups looking to reward employees for seeing Delta Dental PPO dentists. Groups located in areas
where there are a lot of Delta Dental PPO dentists. This
plan is best
for:
delta dental enhanced ppo
See a Delta DentalPremier or Any Other Dentist
Deductible Options – Individual/Family
$25/$75
$50/$150
$75/$225
$25/$75 $50/$150 $75/$225Individual Annual Maximum
The Enhanced PPO includes CheckUp Plus™. With CheckUp Plus™, benefits paid for diagnostic and preventive
services do not apply to the individual annual maximum.
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays once every five years. One-time
application of sealants. Space maintainers as needed.
100%
100%Basic Restorative Services
Emergency treatment to relieve pain, fillings; simple
extractions.
90%*
80%*Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), oral surgery, crowns, complete and partial dentures, implants, fixed bridges, repairs and adjustments.
Note: Groups may upgrade oral surgery, endodontic and periodontic coverage to the basic-restorative-services level.
60%*
50%*Orthodontic Services (Optional)
If the group has 10 or more enrolled employees, it may
choose to include orthodontic coverage. Coverage applies
for dependent children to age 19. Orthodontic coverage is not available for groups under 10.
50%*
50%*Lifetime Orthodontic Maximum
$1,000
$1,500
$2,000
$1,000 $1,500 $2,000Evidence-Based Integrated Care Plan (EBICP)
Delta Dental's Evidence-Based Integrated Care Plan provides expanded benefits for persons with diseases and medical conditions that have oral-health implications. These benefits address the unique oral-health challenges faced by
persons with these conditions, and can play an important role in the management of an individual's
medical condition.
Included
IncludedDependent Age Limitation age 26, except as noted Dependents covered to for orthodontics
Dependents covered to age 26, except as noted
for orthodontics
Vision-Care Discount Program Included
See page 20 for details.
Included
Included*Deductible applies.
Delta Dental Enhanced PPO
A plan that puts the power of the PPO to work.
*Delta Dental PPO network measured by locations. | †As a standard $1,000 annual maximum, $50 deductible plan.
Looking for a better benefit? Delta Dental’s Enhanced PPO delivers top-of-the-line benefits when you see a
PPO provider from the state’s largest dentist network*.
what is an enhanced ppo?
An enhanced PPO offers a higher benefit when you
see a Delta Dental PPO dentist and a standard
benefit when you see a Delta Dental Premier dentist
or a non-network dentist.
what else is included?
Each Delta Dental Enhanced PPO includes:
CheckUp Plus™:
Diagnostic and preventive services don’t count against your annual maximum with CheckUp Plus™.
Evidence-Based Integrated Care Plan (EBICP):
The industry-leading benefit enhancement for
whole-body health, EBICP covers additional cleanings for pregnant women, diabetics, and people with other health conditions. See www.deltadentalwi.com/EBICP for more information.
mac plan option
In addition to your choice of annual maximum and deductible, a MAC (Maximum Allowable Charge) plan option is available, but not required. With a MAC plan, members pay a lower rate, but out-of-pocket expenses can be higher when they see a dentist other than a Delta Dental PPO dentist.
what plans are similarly priced?
For roughly the same price† you can choose:A Delta Dental Passive PPO with a higher annual maximum and/or a lower deductible.
(See page 14)
See a Delta Dental
ppo dentist
Higher in-network coinsurance
keeps money in your wallet.
18 |Page 19 |Page
Delta Dental 2-4
Premier Plus PPO
Delta Dental 2-4
Advantage PPO
See a Delta Dental PPO Dentist See a Delta Dental Premier or Any Other Dentist See a Delta Dental PPO Dentist See a Delta Dental Premier or Any Other Dentist
Deductible Options – Individual/Family $50/$150 $25/$75 $50/$150
Individual Annual Maximum
Delta Dental 2-4 plans include CheckUp Plus™. With CheckUp Plus™, benefits paid for diagnostic and
preventive services do not apply to the individual annual maximum.
$1,000 $1,000
Diagnostic & Preventive Services
Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing X-rays once every 12 months and full-mouth X-rays once every five years. One-time
application of sealants. Space maintainers as needed.
100%* 100%* 100% 80%*
Basic Restorative Services
Emergency treatment to relieve pain, fillings. 80%* 80%* 80%* 70%*
Major Restorative Services
Endodontics and periodontics (root canals and gum-disease treatment), extractions and oral surgery, crowns, complete and partial dentures, implants, fixed bridges, repairs and
adjustments.
50%* 50%* 50%* 40%*
Orthodontic Services Not Covered Not Covered
Evidence-Based Integrated Care Plan (EBICP)
Delta Dental's Evidence-Based Integrated Care Plan provides expanded benefits for persons with diseases
and medical conditions that have oral-health implications.
These benefits address the unique oral-health challenges
faced by persons with these conditions, and can play an important role in the management of an individual's medical condition.
Included Included
Dependent Age Limitation age 26, except as noted for Dependents covered to orthodontics
Dependents covered to age 26, except as noted
for orthodontics
Vision-Care Discount Program Included
See page 20 for details. Included Included
2-4-enrolled dental plans
*Deductible applies.
2-4-Enrolled Delta Dental Plans
We understand the need to watch every penny.
Delta Dental has great dental-benefits options for
Wisconsin’s smallest groups. Choose a PPO plan that rewards employers for using Delta Dental’s sizable
PPO network, or choose a plan with the same benefits
in- and out-of-network. You get Delta Dental’s award-winning customer service no matter which plan you choose.
what else is included?
Each Delta Dental 2-4-Enrolled plan includes:
CheckUp Plus™:
Diagnostic and preventive services don’t count against your annual maximum with CheckUp Plus™.
Evidence-Based Integrated Care Plan (EBICP):
The industry-leading benefit enhancement for
whole-body health, EBICP covers additional cleanings for pregnant women, diabetics, and people with other health conditions. See www.deltadentalwi.com/EBICP for more information.
waiting periods
For groups with an existing dental plan, there are no waiting periods for those enrolling during the initial enrollment period.
Waiting periods apply for groups with no existing dental plan, and for enrollees who waive coverage initially, drop coverage, or who become eligible for the plan after the initial enrollment period (new hires or qualifying events). There is a six-month waiting period for endodontics (root canals), periodontics (gum-disease treatment), extractions, and oral surgery, and a 12-month waiting period for crowns,
implants, complete and partial dentures, fixed
bridges, and repairs and adjustments. There is no
benefit waiting period for diagnostic and preventive
services, or basic restorative services.
2-4-Enrolled Delta Dental Plans
The harder you look,
the better we look.
20 |Page 21 |Page
Vision Discount Program
Vision Discount Program
Member Benefit
Exam with Dilation as Necessary exam/$10 off contact-lens $5 off comprehensive exam
Complete Pair Glasses Purchased
The following discounts and fees for frames, lenses and lens options apply only if a complete
pair is purchased in the same transaction. Items purchased separately will be discounted 20% off of the retail price.
Frames: Any frame available at provider location 30% off retail price
Single Plastic Lenses Including Standard Scratch Coating Single-Vision Bifocal Trifocal Member Pays $75 $95 $125 Lens Option UV Coating
Tint (solid and gradient)
Standard Polycarbonate
Standard Anti-Reflective Coating Standard Progressive (add-on to bifocal)
Member Pays $15 $15 $40 $45 $70
Conventional Contact Lenses: Applied to materials only 15% off retail price
Laser Vision Correction: LASIK or PRK 15% off retail price or 5% off promotional price
Frequency: Exams, frames, lenses, and contact lenses Unlimited
vision discount program
Great savings that are easy to see.
Delta Dental of Wisconsin small-group plans come
with a money-saving Vision Care Discount Program
at no additional cost.
Through our partnership with EyeMed Vision Care®, members save on eyewear, contacts, exams, even
laser vision correction. EyeMed serves more than
140 million people and has a vast network of vision
providers. Best of all, there’s no limit to the number
of times you can use your vision discount.
the discount program features:
• Overall savings up to 35 percent
• Access to thousands of private practice and retail providers nationwide, including LensCrafters®, Target Optical®, Sears Optical®, Shopko® Optical and Pearle Vision®
• Choice of any product, including designer frames • Savings on laser vision correction
• Replacement contact lenses by mail
additional Notes:
• Replacement contact lenses may be
obtained online. Details are available at www.eyemedvisioncare.com/deltadental
• Members receive a 20 percent discount on
items not included under the program, when these items are purchased at participating providers
• Retail prices may vary by location
program exclusions:
• Orthoptic or vision training, subnormal vision aids,
and associated supplemental testing
• Medical and/or surgical treatment of the eye, eyes,
or supporting structures
• Corrective and safety eyewear
• Services provided as a result of any workers’
compensation law
• Plano nonprescription lenses and nonprescription sunglasses (20 percent discount)
22 |Page 23 |Page
Accounting, Auditing, & Bookkeeping Advertising
Agricultural Production – Crops Agricultural Production – Livestock & Animal Specialties
Attorneys & Legal Services Automotive Dealers, New & Used Beauty/Barber Shops
Boat Dealers Bowling Alleys
Business & Professional Organizations Churches
Dentists’ Offices Eating & Drinking Places
Engineering & Architectural Services Exchanges, & Services
Gas Stations, Convenience Stores Highway Passenger Transportation Holding & Other Investment Offices
Home Healthcare
Hospitals, Medical & Dental Labs Hotels, Motels, Campgrounds Insurance Agents, Brokers, & Service Insurance Carriers
Labor, Political, Civic & Social Organizations Local & Suburban Transit & Interurban Management & Public Relations Medical Service & Health Insurance Mobile-Home Dealers
Motorcycle Dealers Movie Theaters
Personal Services
Physician, Other Healthcare Offices Real Estate Brokers
Recreation & Utility-Trailer Dealers Research & Testing Services
Schools, Including Colleges & Universities Security & Commodity Brokers, Dealers, Subdividers & Developers
Transportation Services Travel Agents/Tour Operators Unclassified Health Services
Unclassified Membership Organizations Unclassified Services
Exclusions
Delta Dental small-group plans do not cover the following
(see group contract or handbooks for definitions of terms used in this section):
1. Dental procedures provided or commenced prior to the effective date of the subscriber’s or covered dependent’s coverage under this contract.
2. Dental procedures to treat injuries or conditions com-pensable under workers’ compensation or employers’ liability laws.
3. Prescription drugs and pre-medications. 4. Preventive control programs.
5. Charges for completion of forms. 6. Charges for consultation.
7. Charges by any hospital or other surgical or treatment facility, or any additional fees charged by a dentist for treatment in any such facility.
8. Charges for treatment of, or services related to, temporomandibular joint dysfunction.
9. Services that are determined to be partially or wholly cosmetic in nature.
10. Cast restorations placed on covered dependents under age 12.
11. Prosthetics placed on covered dependents under age 16. 12. Appliances, restorations, or procedures for:
(a) increasing vertical dimension; (b) restoring occlusion;
(c) correcting harmful habits; (d) replacing tooth structure lost by attrition; (e) correcting congenital or developmental malformations except in newly born children; (f) temporary dental procedures; (g) splints, unless necessary as a result of accidental injury.
13. Dental procedures provided by other than a dentist or licensed hygienist employed by a dentist.
14. Dental procedures to treat injuries or diseases caused by riots or any form of civil disobedience.
15. Dental procedures to treat injuries sustained while committing a criminal act.
16. Dental procedures to treat injuries intentionally inflicted. 17. Replacement of lost or stolen dentures or charges for duplicate dentures.
18. Dental procedures in cases for which, in the professional judgment of the attending dentist, a satisfactory result cannot be obtained.
19. Local anesthetic is covered as a part of a dental procedure. General anesthetic or intravenous sedation is a benefit only when billed with covered oral surgery (cutting procedures).
20. Procedures not specifically covered under this contract. 21. If orthodontic procedures are included as benefits under your group’s contract, the repair and replacement of orthodontic appliances are not covered.
Limitations
Coverage for some services under the plan is subject to frequency and age limitations. These limitations and restrictions are described in the handbook and group contract. Copies of these materials are available by calling Delta Dental of Wisconsin at 800-236-3713.
Requirements and considerations
for all delta dental small-group plans
• The plan must be sponsored by the employer. The employer
will collect premiums via payroll deduction.
• A clear employer-employee relationship must exist. • Employment must be full-time, year-round and not experience seasonal layoffs.
• The business has not been cancelled by another dental carrier within the past 36 months.
• Benefit accumulation period is calendar year.
• Subscribers may use the national Delta Dental Premier and Delta Dental PPO dentist networks.
• Retirees are not eligible unless all active employees are eligible for the plan.
• In order to enroll dependents, the employee must be enrolled.
• Only group-billing format is available; no individual billings can be accommodated. Individual COBRA billings are not available.
• The patient’s coinsurance is based on the applicable percentage of the dentist’s billed fee or the maximum plan allowance, whichever is less.
• All contracted services are available to the employee upon the date of eligibility. Note: Benefit waiting periods may apply.
• For groups with open enrollment, an employee who waived coverage or dropped coverage may enroll only during the open enrollment period. Waiting periods may apply.
Stevens Point Office P.O. Box 828
Stevens Point, WI 54481 800-236-3713 (toll-free) Fax 715-343-7623
Milwaukee Office 1233 North Mayfair Road Suite 204 Milwaukee, WI 53226 888-456-2711 (toll-free) Fax 414-607-6088 Madison Office 725 Heartland Trail Suite 205 Madison, WI 53717 877-577-7449 (toll-free) Fax 608-831-9384 • Participation is based on enrollment of all eligible employees except
those who submit waiver cards indicating that they have coverage under their spouse’s plan. Waiver forms are required for all employer-contributory plans.
• Delta Dental small-group plans include coverage for teeth lost prior to the effective date, and pre-existing conditions.
• A Delta Dental small-group plan must be the only dental plan offered. • Rates are guaranteed for one year from the effective date of coverage.
for delta dental table of allowances and 2-4-enrolled
plans only
• The total number of eligible employees and dependents participating
must be equal to or greater than the percentage of the employer contribution. Example: With an employer contribution of 75%, a minimum of 75% of eligible employees must participate.
special requirements for premier plus ppo, enhanced
ppo, savings ppo and ultrasavings ppo plans
• Delta Dental small-group plans are open to groups with 5-49 enrolled
employees.
• Orthodontic coverage is available only to groups of 10 or more enrolled employees.
• If orthodontic coverage is purchased, all families must accept the orthodontic benefit with the same maximum.
special requirements for 2-4 plans
• 2-4 Premier Plus PPO and 2-4 Advantage PPO are open to groups
with 2-4 enrolled employees.
• Two-person groups may not consist of enrollees residing at the same address.
• A company wage and tax statement must accompany the group application.
rate adjustments
The types of businesses listed at right are eligible for the program if they meet other underwriting guidelines, but require an 18 percent adjustment on the standard rates. This list is not all-inclusive. If you are uncertain about the industry type and whether a rate adjustment would apply, contact the sales department. See below for complete contact information.