Dental Insurance

Dental Information

DENTAL CONTACT INFO
www.deltadentalins.com

Application for Dental Insurance

Delta Dental Comprehensive Dental Plan

Two options are available to employees with this dental plan: low option and high option. Both options offer similar benefits for diagnostic/preventive, basic, and major services. Assigned co-insurance, annual limits, and monthly premiums will vary depending on the option elected. A brief overview of each option is provided in the following benefits summary. A more detailed description of benefits is available in the dental flyer and policy book.

Features:

See any dentist
$50 deductible per member per calendar year
$150 family deductible
Diagnostic and preventive service paid at 100% of usual and customary rates (not subject to deductible)

Low Option
The low option may be appropriate for employees who require minimal dental services. This option offers benefits with lower co-insurance for basic and major services at a lower monthly premium. Please note orthodontic benefits are unavailable.

Benefit Summary	Co-insurance Payable on the UCR
Basic Diagnostic and Preventative Benefits: Procedures to assist the dentist in determining required dental treatment (oral examinations, x-rays, emergency office visits); prophylaxis (cleaning); topical application or fluoride solutions and space maintainers twice a year.	100% (No Deductible)
Restoration, Denture Repairs, and Other Basic Services: Amalgam, synthetic porcelain, fillings, procedures for the repair of partial or complete dentures and sealants, oral surgery, and general anesthesia when administered by a dentist for a covered oral surgery procedure.	50% After Deductible
Periodontics/Endodontics,Crowns/Prostodontics: 12-month waiting period Treatment of gums supporting the teeth and the treatment of tooth pulp/root canal therapy. Crowns and cast restoration for treatment of carious lesions when teeth cannot be restored with amalgam, synthetic porcelain or plastic restorations; and procedures for construction of fixed bridges, partial or complete dentures and repair of fixed bridges.	25% After Deductible
Orthodontic Benefits: Not Available	No coverage

Monthly Rates:	12- month	9- month
Employee	$23.54	$31.38
Employee + Family	$49.06	$65.42

Calendar year maximum:	Per patient	$1,000

High Option
The high option offers benefits to employees with a greater need for major dental work or orthodontic benefits.

Benefit Summary	Co-insurance Payable on the UCR
Basic Diagnostic and Preventative Benefits: Procedures to assist the dentist in determining required dental treatment (oral examinations, x-rays, emergency office visits); prophylaxis (cleaning); topical application or fluoride solutions and space maintainers twice a year.	100% (No Deductible)
Restoration, Denture Repairs, and Other Basic Services: Amalgam, synthetic porcelain, fillings, procedures for the repair of partial or complete dentures and sealants, oral surgery, and general anesthesia when administered by a dentist for a covered oral surgery procedure.	80% After Deductible
Periodontics/Endodontics, Crowns/Prostodontics: 12-month waiting period Treatment of gums supporting the teeth and the treatment of tooth pulp/root canal therapy. Crowns and cast restoration for treatment of carious lesions when teeth cannot be restored with amalgam, synthetic porcelain or plastic restorations; and procedures for construction of fixed bridges, partial or complete dentures and repair of fixed bridges.	50% After Deductible
Orthodontic Benefits: children under age 19	50% After Deductible

Monthly Rates:	12- month	9- month
Employee	$33.84	$45.12
Employee + Family	$70.56	$94.08

Calendar year maximums:	Per patient	$1,500
	Lifetime Orthodontic-per patient	$1,200

If your provider does not file your dental claim for you, you may obtain a claim form from the Human Resources website at http://www.olemiss.edu/depts/HR/forms/deltaclaim.pdf. Each covered member of your family may go to their own dental provider. For more information regarding your dental benefits, please call 1-800-521-2651.

Dental insurance cards are available by accessing the Delta Dental website at www.deltadentalins.com. New enrollees should wait approximately 7 – 10 business days from date of application before attempting to print a card. Participants without internet access can contact Human Resources benefits staff at 662-915-7431 to request a card.

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