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Todays Agenda • 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 2
Your Dental Benefit Offerings at a Glance PPO Plan Name 11094 Lo 11093 Hi Solstice Participating Solstice Participating Network Dentist or the dentist of Dentist or the dentist of your choice your choice Maximum $1000 per calendar year $1500 per calendar year Benefit $1000 lifetime maximum $1000 lifetime maximum for Orthodontia for Children up to age 30 Adults and Children 3
PPO Plans 4
Option #3 - PPO Lo 11094 Benefit Level In-Network Out-of-Network Annual Deductible Individual $50 $50 Applies to Preventive & Diagnostic No No $1,000 per covered person $1,000 per covered person Annual Maximum Preventive & Diagnostic Services Periodic Oral Evaluation, Radiographs, Lab 100% of Usual and Customary Fees 100% of Allowed Amount and other Diagnostic Test, Prophylaxis, (60 th percentile) Fluoride Treatment, Sealants, Space Maintainers Basic Services General Services, Complex Oral Surgery, 70% of Usual and Customary Fees Periodontics, Endodontics, Restorations 70% of Allowed Amount (60 th percentile) (Amalgams or Anterior Composite), Emergency Treatment a and Simple Extractions Major Services 40% of Usual and Customary Fees Inlays/Onlays/Crowns, Dentures and 40% of Allowed Amount (60 th percentile) Removable Prosthetics, Fixed Partial Dentures (Bridges) and Implant 40% of Allowed Amount 40% of Usual and Customary Fees Orthodontic Services (60 th percentile ) (Child up to age 30) $1,000 lifetime maximum $1,000 lifetime maximum 5
Option #4 - PPO Hi 11093 Benefit Level In-Network Out-of-Network Annual Deductible Individual $50 $50 Applies to Preventive & Diagnostic No No $1,500 per covered person $1,500 per covered person Annual Maximum Preventive & Diagnostic Services Periodic Oral Evaluation, Radiographs, Lab 100% of Usual and Customary Fees 100% of Allowed Amount and other Diagnostic Test, Prophylaxis, (90 th percentile) Fluoride Treatment, Sealants, Space Maintainers Basic Services General Services, Complex Oral Surgery, 80% of Usual and Customary Fees Periodontics, Endodontics, Restorations 80% of Allowed Amount (90 th percentile) (Amalgams or Anterior Composite), Emergency Treatment a and Simple Extractions Major Services 50% of Usual and Customary Fees Inlays/Onlays/Crowns, Dentures and 50% of Allowed Amount (90 th percentile) Removable Prosthetics, Fixed Partial Dentures (Bridges) and Implant 50% of Allowed Amount 50% of Usual and Customary Fees Orthodontic Services (90 th percentile ) (Adult and Children) $1,000 lifetime maximum $1,000 lifetime maximum 6
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 • Benefits Booster award to help you save • Implant Coverage Included • Prenatal Dental Care Program • 7
Solstice Benefits Booster award to help you save What is Benefits Booster ? Benefits Booster 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 Benefits Booster No penalty if dental services are not used in the year Carry forward unused balances Award balance may be used for out-of-network claims How does Benefits Booster work? Benefits Booster 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:* Option 4 Option 3 Plan Option: PPO Lo 11094 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 9
PPO Plan Rates Monthly Rates Option #3 Option #4 Tiers PPO Lo 11094 PPO Hi 11093 Employee Only $25.94 $32.77 Employee + One Dependent $51.44 $65.12 Employee + Two or More $75.61 $95.70 Dependents 10 10
Prenatal Dental Care Program 11 11
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. 12
Tools 13 13
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 14
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 15
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