DeltaCare

The DeltaCare plan works very much like a Health Maintenance Organization in that you must select a primary care dentist from a list of participating network dentists in order to be enrolled and receive coverage. If you see your primary care dentist (or a network dental specialist referred by your primary care dentist), no deductible is required. Co-payments will generally apply only to major services provided and no claim forms need to be filed by you. The co-payment schedule(s) are available at our website, www.pace.edu/hr or at the Human Resources/Benefits office.

For an updated list of participating providers, please review their website at www.midatlanticdeltadental.com.

Please refer to the plan document for more specific details about the benefits provided

Delta Dental Preferred POS

The Delta Dental Preferred POS plan offers you complete freedom of choice in selecting a dentist. You can choose a dentist in either the DeltaPreferred or DeltaPremier networks or a dentist who does not participate in either network. Your choice of dentist can be determined at the same time services are required and will impact the cost savings you receive.

If you choose a dentist within the DeltaPreferred or DeltaPremier networks, at the time you require services you will enjoy the following benefits:

Here is an example of how Delta Dental POS program works:

* assumes dental service is basic restorative

As you can see from this example, your out of pocket expenses can be reduced by your choice of dentist.

DeltaPreferred dentists are contracted with Delta Dental to accept a lower UCR allowance as payment in full for the services performed. Delta Dental then pays these dentists at a higher percentage (i.e., 90%) as compared to DeltaPremier (i.e., 80%). You are resposible to pay the dentist for the difference between the UCR allowance accepted by the DeltaPreferred dentist and the payment made by Delta Dental.

DeltaPremier dentists will accept a higher UCR allowance as full payment. Delta Dental pays these dentists at a lower percentage (i.e., 80%) as compared to DeltaPreferred (i.e., 90%). Again, you are only responsible to pay the dentist for the difference between the UCR allowance accepted by the DeltaPremier dentist and the payment made by Delta Dental. By choosing a doctor within the DeltaPreferred or DeltaPremier network, your out of pocket expenses will not exceed the UCR allowance accepted by these dentists.

If you choose to receive dental services from a non-participating provider,you will need to pay your dentist in full and then submit a claim to be reimbursed by Delta Dental. Your out of pocket expenses will be determined by your reimbursement from Delta Dental (i.e., 80% of allowed UCR) and the actual fee charged by your dentist.

A small annual deductible will apply ($50/individual; $150/family) for all services other than diagnostic and preventive services, which are covered at 100% (limit one cleaning exam every six months per person).

For an updated list of participating dentists in either the DeltaPreferred or DeltaPremier
networks, please review their website at www.midatlanticdeltadental.com

Annual Benefit Maximum

There is a $2,000 annual benefit maximum per person for in-network or $1,500 for out of network.

For example, if you use an out of network dentist and meet the $1,500 annual benefit maximum, you can then switch to an in-network provider and receive an additional $500 towards your annual benefit maximum. At no time, does the annual benefit maximum exceed $2,000.

Dental Plan Summary

Orthodontic Benefit Maximum – $1,000 lifetime per patient for In-Network and $500 lifetime per patient for Out-of-Network. At no time, does the lifetime benefit maximum exceed $1,000.

Please refer to the plan document for more specific details about the benefits provided.