1 Todays Agenda PPO Plans Lo and Hi Plan Designs PPO Plan - - PowerPoint PPT Presentation

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Todays Agenda

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• PPO Plans – Lo and Hi

 Plan Designs  PPO Plan Features  BenefitsBooster  2015 Monthly Rates

• Prenatal Dental Care Program
• Tools

 Member Services  Dental Website: www.MySolstice.net

Your Dental Benefit Offerings at a Glance

PPO Plan Name 11094 Lo 11093 Hi Network Solstice Participating Dentist or the dentist of your choice Solstice Participating Dentist or the dentist of your choice Maximum Benefit $1000 per calendar year $1500 per calendar year Orthodontia $1000 lifetime maximum for Children up to age 30 $1000 lifetime maximum for Adults and Children

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PPO Plans

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Option #3 - PPO Lo 11094

Benefit Level In-Network Out-of-Network Annual Deductible Individual Applies to Preventive & Diagnostic $50 No $50 No Annual Maximum $1,000 per covered person $1,000 per covered person Preventive & Diagnostic Services Periodic Oral Evaluation, Radiographs, Lab and other Diagnostic Test, Prophylaxis, Fluoride Treatment, Sealants, Space Maintainers 100% of Allowed Amount 100% of Usual and Customary Fees (60th percentile) Basic Services General Services, Complex Oral Surgery, Periodontics, Endodontics, Restorations (Amalgams or Anterior Composite), Emergency Treatment a and Simple Extractions 70% of Allowed Amount 70% of Usual and Customary Fees (60th percentile) Major Services Inlays/Onlays/Crowns, Dentures and Removable Prosthetics, Fixed Partial Dentures (Bridges) and Implant 40% of Allowed Amount 40% of Usual and Customary Fees (60th percentile) Orthodontic Services (Child up to age 30) 40% of Allowed Amount $1,000 lifetime maximum 40% of Usual and Customary Fees (60th percentile ) $1,000 lifetime maximum

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Option #4 - PPO Hi 11093

Benefit Level In-Network Out-of-Network Annual Deductible Individual Applies to Preventive & Diagnostic $50 No $50 No Annual Maximum $1,500 per covered person $1,500 per covered person Preventive & Diagnostic Services Periodic Oral Evaluation, Radiographs, Lab and other Diagnostic Test, Prophylaxis, Fluoride Treatment, Sealants, Space Maintainers 100% of Allowed Amount 100% of Usual and Customary Fees (90th percentile) Basic Services General Services, Complex Oral Surgery, Periodontics, Endodontics, Restorations (Amalgams or Anterior Composite), Emergency Treatment a and Simple Extractions 80% of Allowed Amount 80% of Usual and Customary Fees (90th percentile) Major Services Inlays/Onlays/Crowns, Dentures and Removable Prosthetics, Fixed Partial Dentures (Bridges) and Implant 50% of Allowed Amount 50% of Usual and Customary Fees (90th percentile) Orthodontic Services (Adult and Children) 50% of Allowed Amount $1,000 lifetime maximum 50% of Usual and Customary Fees (90th percentile ) $1,000 lifetime maximum

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PPO Plan Features

• Freedom to see a non-network dentist
• No claim forms when you visit a network dentist
• National network of over 130,000 general dentists and specialists
• See any specialist you want, without a pre-authorization
• BenefitsBooster award to help you save
• Implant Coverage Included
• Prenatal Dental Care Program

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Solstice BenefitsBooster award to help you save

What is BenefitsBooster?

BenefitsBooster is an Increasing Calendar Year Maximum feature included in select Solstice dental plans that puts dental care decisions directly in the hands of the consumer. Members are encouraged to seek care through an awards-based framework that allows them to carry forward part of their unused calendar year maximum.

Highlights of the Solstice BenefitsBooster

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No penalty if dental services are not used in the year

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Carry forward unused balances

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Award balance may be used for out-of-network claims

How does BenefitsBooster work?

BenefitsBooster is designed for dental plans with deductibles and annual maximums. It is administered at the member level giving each member an opportunity to earn their own awards. Members must use their dental benefit as least once a year, and can qualify for an additional bonus if a member utilizes all in network providers. 8

Solstice Dental BenefitsBooster

Example. The charts below show the award dollar and bonus a member can earn:* Plan Option:

Option 3

PPO Lo 11094

Option 4

PPO Hi 11093 Original Annual Maximum $1,000 $1,500 Annual Claim Threshold $500 $750 Carryover Amount $250 $400 Annual Network Bonus $100 $100 Increase Limit $1,000 $1,500 Max Rollover Account Limit $2,000 $3,000

*For plans with a different network versus non-network maximums, we base the award on the non-network maximum

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PPO Plan Rates

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Monthly Rates Tiers

Option #3

PPO Lo 11094

Option #4

PPO Hi 11093 Employee Only $25.94 $32.77 Employee + One Dependent $51.44 $65.12 Employee + Two or More Dependents $75.61 $95.70

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Prenatal Dental Care Program

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Prenatal Dental Care Program

Experts say that disease related to the gums and tooth-support structures (periodontal disease) during pregnancy could lead to an increased risk of pre-term and very pre-term delivery. If you don’t receive treatment for tooth-related disease while pregnant, you could place your unborn child at higher risk for neonatal problems and even life-long disabilities related to pre-term deliveries. In Florida, 1 in 7 babies (13.8% of live births) were born pre-term in 2007. A UNC study indicates that pregnancy women with gum disease may be twice as likely to give birth early. Utilizing our prenatal care program during pregnancy can help prevent pre-term birth caused by periodontal disease. With our program, cleanings for women in their second and third trimesters are covered at 100 percent.

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Tools

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Customer Service

• Customer Service Center

 Available from 8:00 a.m. to 6:00 EST Monday – Friday  Support for non-English speakers. AT&T language line

support more than 170 languages.

 Toll-free teletypewriter (TTY) service for the deaf and

hearing impaired members. Our entire customer service team is able to fully interact with this system.

• Interactive Voice Response (IVR) System

 Provider Locator, benefit information and eligibility.  Toll-free, 24 hours a day, seven day a week.

• Toll-free Number 1.855.557.4120

Our commitment to customer service

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Award Winning Websites: MySolstice.net and SolsticeBenefits.com

• Dental Locator
• Find general dentists and specialists
• Print maps and driving directions
• Plan Information
• Verify eligibility
• View benefit summary
• Order an ID card
• Answers to common dental questions about plans
• Member Schedule of Benefits
• Claims Information
• Review claim status and history
• Link to Explanation of Benefits (EOB)
• Dental Education
• An A-Z guide of dental terminology and dental care tips
• Monthly Member Newsletters

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