1 Todays Agenda Managed Care Plans S700A Lo and S500A Hi - - PowerPoint PPT Presentation

1

Todays Agenda

2

• Managed Care Plans – S700A Lo and S500A Hi

 Commonly Covered Procedures  Managed Care Plan Features  Specialty Referral Process  2015 Monthly Rates

• Tools

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

Your Dental Benefit Offerings at a Glance

DHMO Plan Name S700A Lo S500A Hi Network Solstice Participating Dentist Solstice Participating Dentist Maximum Benefit None None Orthodontia Adult and Child services at a copay Adult and Child services at a copay

3

Managed Care Plans - DHMO

4

5

Option #1 Managed Care Plan S700A Lo : Commonly Covered Procedures

BENEFIT Plan S700A Lo Deductible None Calendar Year Maximum None Claim Forms None Rosters None Primary Dentist Required None Diagnostic/Preventive You Pay Comprehensive Oral Evaluation (D0150) No Charge Periodic Oral Evaluation (D0120) No Charge Routine Prophylaxis (cleaning) - adult (D1110) No Charge - (1 per 6 months) Palliative (emergency) treatment of dental pain (D9110) No Charge X-ray – bitewings - four films (D0274) No Charge - (1 per 12 months) Topical application of fluoride (D1208) No Charge - (1 per 12 months) Extraction of erupted tooth or exposed root (simple extractions) (D7140) $20 Amalgam (fillings) – 1 surface, primary or permanent (D2140) No Charge

6

Option #1 Managed Care Plans S700A Lo : Commonly Covered Procedures

Basic/Restorative Procedures Plan S700A Lo You Pay Endodontic therapy (root canal) – anterior (excluding final restoration) (D3310) $110 Endodontic therapy (root canal) – molar (excluding final restoration) (D3330) $245 Application of sealant per tooth – (D1351) No Charge Major Procedures Crowns – porcelain fused to noble metal (D2752) $245 + Complete dentures – mandibular (D5120) $325 + Pontic (bridge) – porcelain fused to predominantly base metal (D6241) $245 + Periodontics Periodontal scaling and root planing – 4 or more contiguous teeth per quad (D4341) $50 per quadrant + Orthodontics Pre-orthodontic treatment visit (D8660) $35 Comprehensive treatment of transitional dentition (D8070) $2,200 Comprehensive treatment of adolescent transitional dentition (D8080) $2,250 Comprehensive treatment of adult dentition (D8090) $2,350

+ See Exclusions and Limitations for information on additional cost for lab and materials fees

7

Option #2 Managed Care Plan S500A Hi : Commonly Covered Procedures

BENEFIT Plan S500A Hi Deductible None Calendar Year Maximum None Claim Forms None Rosters None Primary Dentist Required None Diagnostic/Preventive You Pay Comprehensive Oral Evaluation (D0150) No Charge Periodic Oral Evaluation (D0120) No Charge Routine Prophylaxis (cleaning) - adult (D1110) No Charge - (1 per 6 months) Palliative (emergency) treatment of dental pain (D9110) No Charge X-ray – bitewings - four films (D0274) No Charge - (1 per 12 months) Topical application of fluoride (D1208) No Charge - (1 per 12 months) Extraction of erupted tooth or exposed root (simple extractions) (D7140) $10 Amalgam (fillings) – 1 surface, primary or permanent (D2140) No Charge

8

Option #2 Managed Care Plans S500A Hi : Commonly Covered Procedures

Basic/Restorative Procedures Plan S500A Hi You Pay Endodontic therapy (root canal) – anterior (excluding final restoration) (D3310) $100 Endodontic therapy (root canal) – molar (excluding final restoration) (D3330) $225 Application of sealant per tooth – (D1351) No Charge Major Procedures Crowns – porcelain fused to noble metal (D2752) $240 + Complete dentures – mandibular (D5120) $260 + Pontic (bridge) – porcelain fused to predominantly base metal (D6241) $240 + Periodontics Periodontal scaling and root planing – 4 or more contiguous teeth per quad (D4341) $45 per quadrant + Orthodontics Pre-orthodontic treatment visit (D8660) $35 Comprehensive treatment of transitional dentition (D8070) $2,000 Comprehensive treatment of adolescent transitional dentition (D8080) $2,050 Comprehensive treatment of adult dentition (D8090) $2,150

+ See Exclusions and Limitations for information on additional cost for lab and materials fees

9

Managed Care Plan Features

The Manage Care Plan offer:



No deductible and no maximums.



No waiting period.



Open Access Provider Network. No Rosters!



2 free routine cleanings a year (one every six months).



2 free evaluations a year (one every six months).



Emergency visits outside Florida are payable up to $100 per occurrence, toward the abatement of pain.



Most X-rays are available at no additional cost to the member.



Discount Implant Service Included.



Orthodontic services coverage available for children and adults.

10

Manage Care Plan Specialty Care Process

Managed Care Plan Rates

Monthly Rates Tier

Option #1

S700A Lo

Option #2

S500A Hi Employee Only $7.93 $13.68 Employee + One Dependent $13.11 $25.42 Employee + Two or More Dependents $19.38 $37.13

11

12

Tools

212

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

13

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

14

15

Brought to you by