Benefits Plans - Dental Plan

Plan Overview
Delta Dental Consumer Toolkit
Additional Resources
Dental Plan Comparison Chart
Dental Plan Rates
Dental Care Outside the U.S.
Definitions, Acronyms, and Common Dental Terms
Dental Plan Book (PDF)


Plan Overview

Delta Dental administers this plan under Delta Dental PPO (Point-of-Service). The following provides a brief description of the plan. To learn more, see Additional Resources and refer to the Delta Dental Consumer Toolkit for detailed information about your dental benefits.

What is Delta Dental PPO (Point-of-Service)?

Delta Dental of Michigan provides dental coverage for eligible University of Michigan faculty, staff, retirees, and graduate students under Delta Dental PPO (Point-of-Service). Delta Dental PPO (Point-of-Service) is Delta Dental’s national preferred provider organization program that gives you access to two of the nation’s largest networks of participating dentists–the Delta Dental PPO network and the Delta Dental Premier network. Although you can go to any licensed dentist anywhere, your out-of-pocket costs are likely to be lower if you go to a dentist who participates in one of these networks.

Three Dental Plan Options Available

You can choose from three dental plan options. All three options provide coverage for preventive care and orthodontic services (for eligible dependent children to age 19). Option 1 does not cover restorative or major services; however, members will pay a discounted rate for these services when they use a Delta PPO or Delta Premier participating dentist.  If you enroll in Options 2 or 3, Delta will pay toward restorative and major services.  Even greater savings are reached by using a Delta PPO or Delta Premier participating dentist. Please refer to the benefit comparison chart for information on benefit levels and covered services. For full details on coverage and limitations of the plan, see the Delta Dental certificate of coverage that is available for download from the Benefits Office website.

If you select Option 1, there is no monthly dental contribution for coverage for you and your enrolled eligible dependents. The university pays the full cost. You may elect Option 2 or Option 3 for yourself and your dependents; however you pay the cost difference between the university contribution for Option 1 and the costs for the other plans.  Note: If you do not elect a dental plan option during your new hire benefit enrollment period, you will be automatically enrolled in Option 1 dental coverage for yourself only. You will not be able to change dental options or add dependents to your coverage until Open Enrollment, which is usually in October, unless you experience a qualified family status change.

How Does the Delta Dental PPO Point-of-Service Work?

The Delta Dental PPO Point-of-Service plan offers two provider networks:  Delta Dental PPO and Delta Dental Premier.  Your out-of-pocket costs are likely to be lower if you go to a Delta Dental PPO participating dentist. PPO dentists have agreed to accept payment according to a schedule established by Delta Dental, and, in most cases, this results in a reduction of their fees. Delta Dental also pays a higher percentage for most covered services if you go to a PPO dentist.

If your dentist is not a PPO dentist, you will have back-up coverage through Delta Dental Premier. Again, your out of-pocket expenses will vary depending on the participating status of the dentist. Your coverage levels will be slightly lower in most cases, but you can still save money.

What are the advantages of choosing a Delta Dental PPO (PPO) dentist?

Delta Dental will pay the PPO dentist directly for covered services based on his or her submitted fee or the amount in the local Delta Dental’s PPO dentist schedule, whichever is less. If the PPO dentist schedule amount is lower than the dentist’s submitted fee, the dentist cannot charge you the difference. This means you will be responsible only for your copayments and deductible, if any, when you go to a PPO dentist for covered services (see the coverage comparison chart). PPO dentists will also fill out and file your claim forms.

What are the advantages of choosing a Delta Dental Premier dentist?

Delta Dental will pay the Premier dentist directly for covered services based on his or her submitted fee or the local Delta Dental maximum approved fee, whichever is less. If the maximum approved fee is lower than the dentist’s submitted fee, the dentist cannot charge you the difference.  As with PPO dentists, this means you will be responsible only for your copayments and deductible, if any, when you go to a Premier dentist for covered services (see the coverage comparison chart). And, like PPO dentists, Premier dentists will fill out and file your claim forms for you.

What if I go to a nonparticipating dentist?

If you go to a dentist who does not participate in Delta Dental PPO or Delta Dental Premier, you will still be covered (see the coverage comparison chart). However, you could save more of your out-of-pocket expenses if you go to a dentist that participates with Delta Dental.  Delta Dental will pay you directly for covered services based on the dentist’s submitted fee or the local Delta Dental’s nonparticipating dentist fee, whichever is less. You will be responsible for paying the dentist whatever he or she charges. See Dental Care Outside the U.S. for information on receiving dental services when you are traveling outside the United States.

How can I find a participating dentist?

To find the names of participating dentists near you, view a Delta Dental dentist directory by viewing Delta Dental’s website at www.deltadentalmi.com.  You can call Delta Dental’s Customer Service department toll-free, at (800) 524-0149.  Delta’s DASI (Delta’s Automated Service Inquiry) system is available 24 hours a day, seven days a week, and can provide you with a list of participating dentists. You can also speak to a Customer Service representative at any time during normal business hours (Monday through Friday from 8:30 a.m. to 8 p.m. Eastern Time).

Does the University of Michigan School of Dentistry participate with Delta Dental?

Yes, with one exception — the Dental Faculty Associates faculty practice plan at the School of Dentistry location only participates with Delta Premier and not Delta PPO. To confirm the Delta network participation level about a specific dental practitioner, contact the Dental School Patient Business Office at (734) 647-8383.

ID card

Delta Dental does not require ID cards and does not issue them to U-M plan members. When visiting a Delta Dental dentist, simply provide your social security number. The dental office can use that information to verify your eligibility and benefits through Delta Dental's website or toll-free number. If you still would like an ID card, you can print a customized ID card on demand using Delta Dental’s Consumer Toolkit online.

How does Delta Dental coordinate coverage with another plan when Delta is the secondary payer?

Delta Dental bases payment on the amount they approve using the maximum approved fee or DPO dentist schedule according to the dentist’s participating status. Delta will pay the balance of that amount after the primary payment or the amount they would pay as primary, whichever is less. The two programs together will not pay more than 100% of covered expenses. A Delta participating dentist cannot balance bill the patient for any difference between the amount charged and the amount Delta approves.

Preauthorization

Whenever you have a question about whether a dental procedure will be covered, you and/or your dentist should contact your dental plan before you begin treatment. Your dentist should contact Delta Dental and request a preauthorization of covered benefits anytime your dental work is expected to exceed $200.

Additional Resources

Several resources are available to find out more about what your dental plan covers:

  • Refer to the Dental Plan booklet that is available for viewing and downloading from the Benefits Books page
  • See the Delta Dental Certificate of Coverage (PDF) available for download from the Benefits Books page.
  • Call Delta Dental's Customer Service department at (800) 524-0149.
  • Refer to the Delta Dental Consumer Toolkit for detailed information about your dental benefits.

     

    Delta Dental Consumer Toolkit – www.toolkitsonline.com/ (opens a new site)

    Stay current on your dental benefits with Delta Dental’s easy-to-use Consumer Toolkit. This secure online tool is designed to give you 24/7 access to important information regarding your dental benefits, including:

    • Eligibility information for yourself and covered dependents;
    • Current benefits information (such as how much of your yearly benefit has been used to date, how much is still available to use, and levels of coverage for specific  dental services);
    • Specific claims information including what has been approved and when it was paid.

    The site also allows you to find participating providers and print claim forms and your own personalized member ID card. Click here to learn more about the Delta Dental Consumer Toolkit (PDF).

    To start using this helpful instrument, log on to www.toolkitsonline.com/ and click on the "Consumer Toolkit" button. First-time users will need to register. NOTE: You will need the subscriber’s (the person whose name is on the benefit package) member ID. The member ID is an assigned number unique to the subscriber. University of Michigan employees may use their Social Security number or their UMID followed by a zero (no space.)

    The privacy of your benefits information is assured. Delta Dental employs state-of-the-art, ultra-secure computer technology to protect your personal information.

 

Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.