Page 11 - Oremor EE Benefits Guide 01-19.pub
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Benefits
Tips for Using Your Dental Benefits
Understand your plan.
Understanding your dental plan’s benefits, including how copays, deduc bles, and calendar year maximum benefits work, is
key to ge ng the most value from your plan and avoiding surprises.
Take advantage of preventive services offered by the plan.
The least expensive way to maintain good oral health is to go to your den st twice each year for an exam and cleaning.
Regular den st visits can help prevent serious health problems such as oral diseases and cancers, and going to the den st is
more affordable in the long run for those who are insured and take advantage of every service.
Both the DHMO and the DPOS plans cover most preven ve services at no charge to you. As an added bonus, the annual
deduc ble is waived for preven ve services on the DPOS dental plan.
Use contracted dental providers.
With the DHMO plan, you must visit your selected network den st for treatment. If you visit another den st, even if that
den st par cipates in the network, your visit won’t be covered. Under the DPOS plan, you have the flexibility to visit any
licensed den st in the EPO or PPO network, however, contracted network providers have a rate agreement with the
insurance company for services rendered. If you use a non‐network provider, your out‐of‐pocket expenses will be higher and
you may be subject to balance billing.
If your current den st is not contracted with any of our network op ons above, you may s ll con nue to see him and receive
benefits from our plan. However, non‐network den st can charge you an amount above our coverage allowance and you
would also be responsible for these charges. To give you some piece of mind, our non‐network allowances are typically
considered acceptable by 8 out of every 10 den sts.
Ask for a predetermination of benefits.
We strongly recommend you ask your den st for a predetermina on if total charges are expected to exceed $300.
Predetermina on enables you and your den st to know in advance what the payment will be for any service that may be in
ques on.
Know your plan’s limits.
The DPOS dental plan includes an $2,000 calendar year maximum benefit for the EPO er of the plan, a $1,500 calendar year
maximum benefit for the PPO er of the plan, and $1,000 calendar year maximum benefit for the non‐network er of the
plan each member of your family members. A calendar year maximum benefit is the total maximum amount the plan will pay
per year for dental benefits. This amount renews at the beginning of each calendar year. If you do not use this amount, it
doesn’t roll‐over and you’ll lose it.
In addi on to the calendar year maximum, the DHMO and DPOS plans limit the number of cleanings to twice per year. Other
limita ons may apply. If you are unsure, ask your den st to verify with you.
Schedule your procedures to make the most of your dental coverage.
As part of dental planning, you should consult with your den st and, if possible, delay non‐urgent procedures that would push
your out‐of‐pocket costs over your plan’s calendar year maximum benefit. If possible, plan your procedures in such a way that
your annual maximum renews itself in between stages.
Discuss alternative procedures when necessary.
By le ng your den st know that cost is an issue, he or she may be able to suggest alterna ve treatments that are less
expensive but just as effec ve.
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