State of Colorado Open Enrollment 2015-2016, Effective July 1.
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Transcript of State of Colorado Open Enrollment 2015-2016, Effective July 1.
![Page 1: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/1.jpg)
State of Colorado Open Enrollment 2015-2016, Effective July 1
![Page 2: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/2.jpg)
Covering Colorado smiles for more than 57 Years.
![Page 3: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/3.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 4: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/4.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 5: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/5.jpg)
Premier®
PPOSM
We have 3,175 Premier providers and 2,097 PPO
providers in Colorado.
92% of all Colorado dentists are in our
network… and we’re growing!
TWO NETWORKS WORKING TOGETHER
![Page 6: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/6.jpg)
Porcelain Crown Delta Dental
PPOSM
Delta Dental Premier®
Non-Participating
Average Submitted Charge $1,297.07 $1,297.07 $1,297.07
DDCO Contracted Allowance $815.00 $1,090.00 $815.00 *
Member Co-Share 50% 50% 50%
Balance Billed to Member (Submitted vs. Contracted fee)
$0.00 $0.00 $482.07
Total Member Cost(Balance Billed + Co-Share)
$407.50 $545.00 $889.57
* No Contract Exists for Non-Par Dentists
BEST VALUE FOR MEMBERSOur deeper discounts help you save on out-of-pocket costs
![Page 7: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/7.jpg)
• Visit our website• Call customer service• Use the mobile app
Finding a dentist is easy.
![Page 8: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/8.jpg)
NETWORK UTILIZATION
PPOPremierNon-Par
You save the most money when you see a PPO dentist.
![Page 9: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/9.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 10: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/10.jpg)
Services PPO Dentists Premier DentistsOut-of-Network
Dentists
ReimbursementDDCO pays dentist @ PPO
Allowable Fee
*DDCO pays dentist @ Premier Maximum Plan
Allowance
**DDCO pays dentist @ PPO Allowable Fee. Member
responsible for difference up to billed charge.
Diagnostic &Preventive Services (1)
Basic Services 70% 70%* 70%**
Major Services 50% 50%* 50%**
Orthodontics N/A N/A N/A
Deductible:IndividualFamily
Maximum:
(1) Prevention First
Annual Plan Maximum (1) $1,000
Claims for Diagnostic / Preventive Services do not count towards the annual plan maximum
100% 100%* 100%**
$50 $150
2015 BASIC PLAN
![Page 11: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/11.jpg)
Services PPO Dentists Premier DentistsOut-of-Network
Dentists
ReimbursementDDCO pays dentist @ PPO
Allowable Fee
*DDCO pays dentist @ Premier Maximum Plan
Allowance
**DDCO pays dentist @ PPO Allowable Fee. Member
responsible for difference up to billed charge.
Diagnostic &Preventive Services (1)
Basic Services 80% 80%* 80%**
Major Services 50% 50%* 50%**
Orthodontics 50% 50%* 50%**
Deductible:IndividualFamily Limit
Maximums:Annual Plan Maximum (1)
Lifetime Ortho Max
(1) Prevention FirstClaims for Diagnostic / Preventive Services do not count towards the
annual plan maximum
$2,000 $2,000
100% 100%* 100%**
$50 $150
2015 BASIC PLUS PLAN
![Page 12: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/12.jpg)
Dependents under age 5 are covered at
no cost to you.
![Page 13: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/13.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 14: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/14.jpg)
Did you know?
• 90% of systemic disease have signs and symptoms in and around the mouth.
• Regular dental cleanings can help catch serious diseases like cancer, heart disease, and diabetes.
![Page 15: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/15.jpg)
PREVENTION FIRST
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TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 17: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/17.jpg)
EYEMED
Don’t forget that you have a discount vision plan, included at no additional cost.
![Page 18: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/18.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 19: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/19.jpg)
A website built with you in mind.
• Cost Estimator• Risk Assessment Tool• Benefits and Claims
Updates• Oral Health Flyers
www.deltadentalco.com
![Page 20: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/20.jpg)
EMPLOYEE TOOLSThe online portal that makesyour life easier
• View claims and benefits• Electronic EOB• Print an ID card• Oral health and wellness
information• Provider Search
![Page 21: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/21.jpg)
MOBILE APPWhen you need info on the go
Find a dentist
View benefits and claims
Mobile ID card
Toothbrush timer
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![Page 22: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/22.jpg)
TODAY’S DISCUSSION
Network Highlights and Utilization
2015 PlanDesigns
Importance of Prevention
Online Tools
Eyemed Customer Service
![Page 23: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/23.jpg)
LOCAL SERVICEService you need when you need it…because we live where you live
Phone:1-800-610-0201
Email:[email protected]
Hours:Monday – Friday 8 a.m. – 6 p.m.
24/7 Automated Call Center
![Page 24: State of Colorado Open Enrollment 2015-2016, Effective July 1.](https://reader035.fdocuments.net/reader035/viewer/2022062320/56649cef5503460f949bcccb/html5/thumbnails/24.jpg)
We are the champion of your smile.