Dental insurance for employers with 2 to 49 enrollees A suite of PPO plans, incorporating Wisconsin’s largest dentist networks, award-winning local service, and an unmatched record of rate stability. Form 1292 - 7/10 ! 2 page What groups select Deductibles Annual Maximums Other $0 $1500 $1000 $50 $25 er Oth $2000 $750 $1200 Groups also overwhelmingly choose 100% coinsurance for Preventive, 80% for Basic, and 50% for Major coverage. Employer Selection of Benefits Basic Services Covered at Covered at in-network 90% 80% Basic Services Covered at Covered at 60% 50% out-of-network 80% Major Services Covered at Covered at in-network 60% 50% Major Services Covered at out-of-network 40% 50% Endodontics & Covered in Covered in Periodontics Major Services Basic Services 3 page What’s best for my group? Passive PPO Preferred Provider Option (PPO) savings with minimum disruption. Enhanced PPO Richer benefits for seeing PPO dentists – Delta Dental of Wisconsin has the most PPO locations in Wisconsin. Savings PPO Lower rates* and more places to see a PPO dentist than any competing network. *Compared to Delta Dental’s Passive PPO and Enhanced PPO. UltraSavings PPO Ideal for groups in areas with lots of PPO dentists. Sue Roseliep Account Executive for Madison, southwestern, western, and northern Wisconsin, specializing in under-100-life groups. 4 page Networks Compare Delta Dental’s networks … to anyone. Delta Dental Networks Is your dentist in Network Type Savings Hassle the network? 1,400 dentist locations Protection statewide; 30% of Employees who use a against balance- Delta Dental’s Wisconsin dentist locations; Delta Dental PPO dentist the most places to see billing; claims PPO network can save 15% -30%. paid directly; less a PPO dentist of any Wisconsin PPO network.* hassle. 2,300 additional dentist Added Value No balance-billing; Delta Dental’s locations statewide. Employees who use a claims still paid Premier 57% of Wisconsin dentist Delta Dental Premier directly; less locations are in the Delta dentist can save 5% -7%. network hassle – much like the Dental Premier network.* Delta Dental PPO. No protection from Out-of-network Fewer than 600 dentist balance-billing; more No savings. providers locations statewide. hassle. Summary More in-network More Savings Less Hassle dentists The Delta Dental PPO network has 30% of Wisconsin’s dentist locations. Another 60% of dentist locations are in the Delta Dental Premier network. Patients who see those dentists save money, have less paperwork, and enjoy protection from balance-billing. Fewer than 15% of Wisconsin’s dentist locations are out of Delta Dental’s networks. * Based on Delta Dental’s study of audited dentist locations conducted January 2010. 5 page Competitor Networks Is your dentist in Hassle Savings Network Type the network? Competitor plans Protection against average 880 dentist balance-billing; Employees who use a locations statewide, claims paid PPO dentist can save PPO providers 15% -30%. or approximately 20% directly; of Wisconsin dentist less hassle. locations.* Members may need to file paperwork, 3,300 dentist pay claims and be locations statewide, reimbursed by the No savings for or approximately 80% carrier. No protection employees who use an Out-of-network of Wisconsin dentist from balance-billing, out-of-network dentist. locations, so most providers either. Added work for employees will see an the employee; more out-of-network dentist.* hassle. More Hassle Less Savings More out-of- Summary network dentists * The average PPO network has only about 20% of Wisconsin’s dentist locations. The remaining 80% of dentist locations are out-of-network, and that typically means no savings, more hassles. 6 page Service Delta Dental of Wisconsin’s Unified Call Center routes customer-service calls first to our award-winning call center in Stevens Point, Wisconsin. No matter how busy we are, your call never leaves the Midwest. Couple this with Delta Dental’s category-leading performance in important customer-service measurements such as average speed of answer and first-call resolution and the result is customer-service questions answered locally, quickly, and expertly. The speed and professionalism of Delta Dental customer service reduces the hassle factor and provides unmatched value to members and groups. Employer Satisfaction er Oth RENEWAL RATE 97% or higher† RATE STABILITY Rated #1 in Wisconsin by insurance agents* SAVINGS DDWI saved employers and subscribers over $104 million in 2009† ACCESS ACCOUNT All services are provided through our home office in Wisconsin ADMINISTRATION Customer Service and Call Center LOCATION Wisconsin-based service center RESOLUTION 99.8% of calls resolved on initial contact‡ EXPERIENCE Call-center employees average over 9 years’ experience at DDWI ACCOMPLISHMENTS Certified “Center of Excellence” AVERAGE ANSWER 15 seconds‡ TIME Claims Processing and Accuracy CLAIM TURNAROUND 3 calendar days‡ CLAIM ACCURACY 99%‡ PAYMENT ACCURACY 99%‡ * Source: 2010 Agent-Benchmarking Survey. † Source: Delta Dental normative data. ‡ Source: Delta Dental Customer Service Statistics 7 page Plan options 5-49 enrolled employees? Highlights Employer contribution requirement: Benefit waiting periods optional - 5-9 enrolled — 50-100% (see page 13 for details) - 10-49 enrolled — 0-100% Wide range of plan designs Startup groups now accepted Vision-discount plan included Evidence-Based CheckUp Plus : TM Integrated Diagnostic and preventive Care Plan Included benefits don’t count Delta Dental’s Evidence-Based Integrated Care Plan against annual maximum (EBICP) provides expanded benefits for persons with diseases and medical conditions that have oral- Delta Dental of Wisconsin’s CheckUp Plus TM health implications. These benefits address the unique program allows enrollees to obtain diagnostic and oral-health challenges faced by persons with these preventive services without those costs applying to their conditions, and can play an important role in the annual maximum benefit. management of an individual’s medical condition. This option encourages enrollees to seek preventive care, possibly reducing the need for more expensive restorative dental services that can result from undetected problems. Rates based on enrolled participants 5-9 enrolled 10-24 enrolled 25-49 enrolled 8 Plan Options: 5-49 Enrolled Employees page Highlights: • enefit waiting periods optional B Premier Plus PPO • Employer contribution requirement: (see page 13) 5-9 enrolled -- 50-100% • Wide range of plan designs See a Delta Dental See a Delta Dental 10-49 enrolled -- 0-100% • Vision discount plan included PPO dentist Premier or any other dentist Deductible Options - Individual/Family $25/$75 (* indicates where deductible applies) $50/$150 $75/$225 Individual Annual Maximum Options $1,000 All MaxiMizer plans include CheckUp Plus . With CheckUp Plus , benefits paid for TM TM $1,500 diagnostic and preventive services do not apply to the individual annual maximum. See page 7 for additional information. $2,000 Diagnostic & Preventive Services 100% 100% Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing x-rays once every 12 months, & full-mouth x-rays every five years. One-time application of sealants. Space maintainers as needed. Basic Restorative Services - Type 1 80%* 80%* Emergency treatment to relieve pain; fillings. Basic Restorative Services - Type 2 80%* 80%* Simple extractions. Major Restorative Services 50%* 50%* Endodontics and periodontics (root canals and gum-disease treatment), oral surgery, crowns, complete & partial dentures, implants, fixed bridges, repairs & adjustments. Note: Groups may choose to upgrade oral surgery, endodontic & periodontic coverage to the basic restorative services level, except with UltraSavings PPO. Orthodontic Services (Optional) 50%* 50%* If the group has 10 or more enrolled employees, it may choose to include orthodontic coverage. Coverage applies for dependent children to age 19. Orthodontic coverage is not available for groups under 10. Lifetime Orthodontic Maximum Options $1,000 $1,500 $2,000 Evidence-Based Integrated Care Plan Included – See page 7 for details Delta Dental’s Evidence-Based Integrated Care Plan (EBICP) provides expanded benefits for persons with diseases and medical conditions that have oral-health implications. These benefits address the unique oral-health challenges faced by persons with these conditions, and can play an important role in the management of an individual’s medical condition. Dependent Age Limitation Dependents covered to age 27, except as noted for orthodontics Vision Care Discount Program Included – See page 11 for details See page 11 for details. 9 page Enhanced PPO Savings PPO UltraSavings PPO See a Delta Dental See a Delta Dental See a Delta Dental See a Delta Dental See a Delta Dental See a Delta Dental PPO dentist Premier or any other PPO dentist Premier or any other PPO dentist Premier or any other dentist dentist dentist $25/$75 $25/$75 $25/$75 $50/$150 $50/$150 $50/$150 $75/$225 $75/$225 $1,000 $1,000 $1,000 $750 $1,500 $1,500 $2,000 $2,000 100% 100% 100% 100% 100% 80%* 90%* 80%* 80%* 60%* 80%* 50%* 90%* 80%* 80%* 60%* 50%* 40%* 60%* 50%* 50%* 50%* 50%* 40%* 50%* 50%* 50%* 50%* 50%* 50%* $1,000 $1,000 $1,000 $750 $1,500 $1,500 $2,000 $2,000 Included – See page 7 for details Included – See page 7 for details Included – See page 7 for details Dependents covered to age 27, Dependents covered to age 27, Dependents covered to age 27, except as noted for orthodontics except as noted for orthodontics except as noted for orthodontics Included – See page 11 for details Included – See page 11 for details Included – See page 11 for details 10 page Plan options employees 2-4 enrolled 2-4 Premier Plus 2-4 Advantage Highlights: • Employer contribution required: 50%-100% PPO PPO See a Delta See a Delta Dental See a Delta See a Delta Dental • Vision-discount plan included Dental PPO Premier or any Dental PPO Premier or any dentist other dentist dentist other dentist Deductible Options - Individual/Family $50/$150 $25/$75 $50/$150 (* indicates where deductible applies) Individual Annual Maximum Options $1,000 $1,000 All MaxiMizer plans include CheckUp Plus . Benefits paid for TM diagnostic and preventive services do not apply to the individual annual maximum. See page 7 for additional information. Diagnostic & Preventive Services 100%* 100%* 100% 80%* Examinations, teeth cleanings, fluoride treatments once every six months. Bitewing x-rays once every 12 months, & full-mouth x-rays every five years. One-time application of sealants. Space maintainers as needed. Basic Restorative Services 80%* 80%* 80%* 70%* Emergency treatment to relieve pain; fillings. Major Restorative Services 50%* 50%* 50%* 40%* Endodontics and periodontics (root canals and gum-disease treatment), extractions and oral surgery, crowns, complete & partial dentures, implants, fixed bridges, repairs & adjustments. Orthodontic Services Not covered Not Covered Evidence-Based Integrated Care Plan Included – See page 7 for details Included – See page 7 for details Delta Dental’s Evidence-Based Integrated Care Plan (EBICP) provides expanded benefits for persons with diseases and medical conditions that have oral health implications. For more details see page 7. Dependent Age Limitation Dependents covered to age 27 Dependents covered to age 27 Vision Care Discount Program Included – See page 11 for details Included – See page 11 for details Benefit Waiting Periods May apply -- See page 13 for details May apply -- See page 13 for details 11 VISION page Vision Discount All MaxiMizer plans include a vision-care discount program The program utilizes a nationwide network administered by EyeMed Vision Care. The plan provides: • Overall savings up to 35% (see benefit description below) • Access to thousands of private practice and retail providers nationwide, including LensCrafters®, Target Optical®, Sears Optical®, Shopko® Optical and Pearle Vision® • Choice of any product, including designer brand-name frames • Savings on laser vision correction • Replacement contact lenses by mail Heidi Fischer, Marketing Coordinator Service Member Benefit Exam with Dilation as Necessary $5 off comprehensive exam / $10 off contact lens exam Complete Pair Glasses Purchased: • The following discounts and fees for frames, lenses, and lens options apply only if a complete pair is purchased in the same transaction. • Items purchased separately will be discounted 20% off of the retail price. Frames: Any frame available at provider location 30% off retail price Single Plastic Lenses Including Standard Scratch Coating: Member Pays Single Vision $75 Bifocal $95 Trifocal $125 Lens Options: Member Pays UV Coating $15 Tint (solid and gradient) $15 Standard Polycarbonate $40 Standard Anti-Reflective Coating $45 Standard Progressive (add-on to bifocal) $70 Conventional Contact Lenses: (Applied to materials only) 15% off retail price Laser Vision Correction: LASIK or PRK 15% off retail price or 5% off promotional price Frequency: Exams, Frames, Lenses and Contact Lenses Unlimited Additional Notes: Plan Limitations/Exclusions: • After initial purchase, replacement contact lenses may be obtained via the • Orthoptic or vision training, subnormal vision aids, and associated Internet at substantial savings and mailed directly to the member. Details supplemental testing. are available at www.eyemedvisioncare.com/deltadental. • Medical and/or surgical treatment of the eye, eyes, or supporting structures. • Member will receive 20% discount on items purchased at participating • Corrective eyewear required by an employer as a condition of providers not included under the plan coverage. 20% discount may not be employment, and safety eyewear unless specifically covered under plan. combined with any other discounts or promotional offers, and the discount • Services provided as a result of any Worker’s Compensation law. does not apply to EyeMed provider’s professional services, or contact lenses. • Plano nonprescription lenses and nonprescription sunglasses (except for • Retail prices may vary by location. 20% discount). 12 UNDERWRITING page Underwriting Guidelines Group acceptance is not guaranteed. Approval of coverage is contingent upon underwriting acceptance. Requirements and considerations for all MaxiMizer plans • The plan must be sponsored by the employer. The employer will collect premiums via payroll deduction. • A clear employer-employee relationship must exist. • Employment must be full time, year-round and not experience seasonal layoffs. • The business has not been cancelled by another dental carrier within the past 36 months. • Benefit accumulation period is calendar year. • Subscribers may use the national Delta Dental Premier and Delta Dental PPO dentist networks. • Retirees are not eligible unless all active employees are eligible for the plan. • In order to enroll dependents, the employee must be enrolled. • Only group-billing format is available; no individual billings can be accommodated. Individual COBRA billings are not available. • The patient’s coinsurance is based on the applicable percentage of the dentist’s billed fee or the maximum plan allowance, whichever is less. • All contracted services are available to the employee upon the date of eligibility. Note: Benefit waiting periods may apply. • For groups with open-enrollment, an employee who waived coverage or dropped coverage may enroll only during the open-enrollment period. Waiting periods may apply. • The total number of eligible employees and dependents participating must be equal to or greater than the percentage of the employer contribution. Example: With an employer contribution of 75%, a minimum of 75% of eligible employees must participate. • Participation is based on enrollment of all eligible employees except those who submit waiver cards indicating that they have coverage under their spouse’s plan. Waiver forms are required for all employer-contributory plans. • MaxiMizer plans include coverage for teeth lost prior to the effective date, and pre- existing conditions. • MaxiMizer must be the only dental plan offered. • Rates are guaranteed for one year from the effective date of coverage. Michele Knoll, Inside Sales Representative 10 years experience at Delta Dental 13 page Special requirements for MaxiMizer Premier Plus PPO, Enhanced PPO, Savings PPO and UltraSavings PPO plans • MaxiMizer Premier Plus PPO, Enhanced PPO, Savings PPO and UltraSavings PPO are open to groups with 5 to 49 enrolled employees. • Voluntary plans require 10 or more enrolled employees. For groups of 5-9, a minimum 50% employer contribution is required to both single and family rates. • Orthodontic coverage is available only to groups of 10 or more enrolled employees. • If orthodontic coverage is purchased, all families must accept the orthodontic benefit with the same maximum. Special requirements for MaxiMizer 2-4 plans • MaxiMizer 2-4 Premier Plus PPO and 2-4 Advantage PPO are open to groups with 2-4 enrolled employees. • Two-person groups may not consist of enrollees residing at the same address. • A minimum 50% employer contribution is required to both single and family rates. • A company wage and tax statement must accompany the group application. Waiting periods for MaxiMizer 2-4 plans For groups with an existing dental plan, there are no benefit waiting periods for those who enroll during the initial enrollment period. For groups with no existing dental plan, waiting periods apply. There is no benefit waiting period for diagnostic and preventive services, or basic restorative services. There is a six-month waiting period for endodontics and periodontics (root canal and gum disease treatment), extractions and oral surgery; and a 12-month waiting period for crowns, implants, complete and partial dentures, fixed bridges, and repairs and adjustments. For all enrollees who waive coverage initially, drop coverage, or who become eligible for the plan after the initial enrollment period (new hires or qualifying events), waiting periods apply. There is no benefit waiting period for diagnostic and preventive services, or basic restorative services. There is a six-month waiting period for endodontics and periodontics (root canal and gum-disease treatment) extractions and oral surgery; and a 12-month waiting period for crowns, implants, complete and partial dentures, fixed bridges, and repairs and adjustments. Other MaxiMizer plans for groups with an existing dental plan, benefit waiting periods are not available. for groups with no existing dental plan, waiting periods may be chosen, structured in the following manner: There is no benefit waiting period for diagnostic and preventive services, or basic restorative services. There is a six-month waiting period for endodontics and periodontics (root canal and gum-disease treatment) and oral surgery (except simple extractions); and a 12-month waiting period for orthodontics, crowns (except stainless-steel), implants, complete and partial dentures, fixed bridges, and repairs and adjustments. These waiting periods apply to all employees, regardless of when or how they enroll on the plan. 14 page Special Rate Adjustment The types of businesses listed below are eligible for the MaxiMizer program if they meet other underwriting guidelines, but require a 19% adjustment on the standard rates. This list is not all-inclusive. If you are uncertain about the industry type and whether a rate adjustment would apply, contact the sales department at our Stevens Point, Milwaukee, or Madison offices. See the back page of this brochure for complete contact information. Accounting, auditing, and bookkeeping Eating and drinking establishments Management and public relations Advertising agencies Engineering and architectural services Medical service and health insurance Attorneys Farms Mobile-home dealers Automotive dealers, new and used Gas stations, convenience stores Motorcycle dealers Beauty/barber shops Home health care Movie theaters Boat dealers Hospitals, medical and dental labs Physician, other health-care offices Bowling alleys Hotels, motels, campgrounds Recreation and utility-trailer dealers Brokers (real-estate, stock, food, etc.) Insurance agents, brokers and service Research and testing services Business and professional organizations Labor organizations Schools, including colleges and universities Churches Local and suburban passenger transportation Subdividers and developers Dentist offices Political, civic and social organizations Travel agents/tour operators Exclusions MaxiMizer does not provide coverage for the following (see group contract or handbooks for definitions of terms used in this section): 1. Dental procedures provided or commenced 10. Cast restorations placed on covered while committing a criminal act. prior to the effective date of the subscriber’s dependents under age 12. 16. Dental procedures to treat injuries or covered dependent’s coverage under this 11. Prosthetics placed on covered dependents intentionally inflicted. contract. under age 16. 17. Replacement of lost or stolen dentures or 2. Dental procedures to treat injuries or 12. Appliances, restorations, or procedures for: charges for duplicate dentures. conditions compensable under worker’s (a) increasing vertical dimension; (b) restoring 18. Dental procedures in cases for which, in the compensation or employer’s liability laws. occlusion; (c) correcting harmful habits; (d) professional judgment of the attending dentist, 3. Prescription drugs and pre-medications. replacing tooth structure lost by attrition; a satisfactory result cannot be obtained. 4. Preventive control programs. (e) correcting congenital or developmental 19. Local anesthetic is covered as a part of 5. Charges for completion of forms. malformations except in newly born children; (f) a dental procedure. General anesthetic or 6. Charges for consultation. temporary dental procedures; (g) splints, unless intravenous sedation is a benefit only when 7. Charges by any hospital or other surgical necessary as a result of accidental injury. billed with covered oral surgery (cutting or treatment facility, or any additional fees 13. Dental procedures provided by other than procedures). charged by a dentist for treatment in any such a dentist or licensed hygienist employed by 20. Procedures not specifically covered under facility. a dentist. this contract. 8. Charges for treatment of, or services related 14. Dental procedures to treat injuries or 21. If orthodontic procedures are included to, temporomandibular joint dysfunction. diseases caused by riots or any form of civil as benefits under your group’s contract, 9. Services that are determined to be partially or disobedience. the repair and replacement of orthodontic wholly cosmetic in nature. 15. Dental procedures to treat injuries sustained appliances are not covered. Limitations Coverage for some services under the MaxiMizer plan is subject to frequency and age limitations. These limitations and restrictions are described in the handbook and group contract. Copies of these materials are available by calling Delta Dental of Wisconsin at 800-236-3713. Stevens Point Office P.O. Box 828 Stevens Point, WI 54481 800-236-3713 (toll-free) Fax 715-343-7623 Milwaukee Office 1233 North Mayfair Road, Suite 204 Milwaukee, WI 53226 888-456-2711 (toll-free) Fax 414-607-6088 Madison Office 725 Heartland Trail, Suite 205 Madison, WI 53717 877-577-7449 (toll-free) Fax 608-831-9384 Experience. The Delta Dental Difference.
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