New UBT Dental Plan FAQ

Did my benefits change? No. Your benefits are not changing! However, your dental claims administrator is changing to Delta Dental of Ohio effective July 1, 2010. Your UBT Trustees, through a competitive bid process, evaluated several carriers and as a result of increased provider access and savings to members and the fund, selected Delta Dental of Ohio to provide dental benefits to UBT members. You will be covered under one plan, the UBT Delta Dental program, and the dentist you choose will determine what your plan payment will be.

What is the UBT Dental Plan? It is administered by Delta Dental of Ohio. This plan is Delta Dental’s PPO (Point-of-Service) plan, which gives you one plan with three points of service. The point of service determines what the plan pays by the dentist or provider “YOU” choose. Each time you visit a dentist for services, YOU can choose your point of service. You can choose a Delta Dental PPO dentist, a Delta Dental Premier dentist, or a non-participating dentist.

What are the advantages of choosing a Delta Dental PPO dentist? You will receive the highest plan benefits if you seek treatment from a Delta Dental PPO dentist. All Delta Dental PPO dentists have agreed to accept Delta Dental’s PPO schedule as payment in full and cannot balance bill you for the difference between the dental charge and the scheduled amount. This means you will only be responsible for your deductible, if any, and your co-insurance for class 3 and 4 services when you go to a participating Delta Dental PPO dentist for covered services. Your co-insurance is 0% of the allowed amount for class 1 and 2 services, 40% for class 3 services and 50% for class 4 services.

What are the advantages of choosing a Delta Dental Premier dentist? Like Delta Dental PPO dentists, Delta Dental Premier dentists have agreed to accept Delta Dental’s allowed amount as payment in full and cannot balance bill you for the difference between the dental charge and the allowed amount. This means you will only be responsible for your deductible, if any, and your co-insurance for class 2, 3 and 4 services when you go to a participating Delta Dental Premier dentist for covered services. Your co-insurance is 0% of the allowed amount for class 1 services, 35% for class 2 services and 50% for class 3 and 4 services.

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, your co-insurance is 0% of the allowed amount for class 1 services, 35% for class 2 services and 50% for class 3 and 4 services. You will also be responsible for any difference between the submitted fee and allowed amount (balance billing).

What is balance billing? Additional amounts a nonparticipating dentist charges you for the difference between Delta Dental’s allowed amount and the dentist’s fee. Participating dentists agree to accept Delta Dental's allowed fee and charge you only the copayments and deductibles, if applicable. Non-participating dentists may charge you the difference between Delta Dental’s allowed amount and their fee and may also require you to pay the full charge up front.

How do I find a dentist that participates in the Delta PPO or the Delta Premier? To find the names of participating dentists near you, call Delta Dental’s Customer Service department, toll-free, at (877) 334-5008. Our DASI (Delta’s Automated Service Inquiry) system is available 24 hours a day, seven days a week, and can provide you with the names of PPO dentists near you. You can also find information online at www.deltadentaloh.com. or by linking through the UBT website at www.benefitstrust.org.

How are preventative and diagnostic services covered? These services are covered at 100%. If you use a PPO or Premier network provider they will accept Delta Dental’s payment as payment in full. If you use a non-participating provider, your coverage level is 100%, but you can be billed for the difference between the billed amount and the Delta Dental payment (balance billing).

What is Delta Dental PPO (Point-of-Service)? The plan allows the patient to choose the plan payment based on the provider chosen to perform the dental services each time dental services are sought.

How will orthodontic claims be processed? Orthodontia services are for dependent children only. The plan pays 50% or $1,500 whichever is less.

How will ortho claims be processed if currently in-treatment? If one of your family members is in the middle of orthodontic treatment and has not yet reached his or her lifetime orthodontic maximum, ask the dentist to submit a claim with the complete treatment plan to us as if he or she was submitting the claim for the first time. We will use the information on this claim to calculate the remaining liability based on the number of months left in the treatment plan. We will then make monthly payments until treatment ends or until your family member reaches the lifetime orthodontic maximum. Delta Dental will receive your claim history. This means any amounts paid previously will be applied to your lifetime maximum.

What if I have a predetermination that was approved prior to July 1, 2010? For any outstanding predetermination that you have with MetLife, we encourage you to have these services rendered prior to July 1, 2010. Or, you can ask your dentist to re-submit your predetermination to Delta Dental of Ohio after July 1, 2010. However, we will accept a predetermination issued by MetLife as long as the dental services are rendered by October 1, 2010. Your estimated copayment may be different from MetLife’s predetermination as benefits will be determined according to the participating status of your dentist.

What happens after July 1, 2010 to claims for services that require more than one appointment to complete, but started prior to the July 1 transition to Delta Dental (other than orthodontia)? MetLife will pay your claim, Should you have a claim for a multiple appointment service (including dentures, implants, root canals, crowns, etc) that started prior to July 1, 2010, have your provider submit the claim to Metife. Services are typically completed within 90 days and will be paid based on the MetLife original payment levels.

Can I view my own dental information? If you have Internet access, you can access Consumer Toolkit (www.deltadentaloh.com) to access your own benefit, claims, and eligibility information 24 hours a day, seven days a week. You can use this Toolkit to search our dentist directories, print ID cards and claim forms, and read oral health tips, too.

Where do I mail claims? Mail claims to Delta Dental, P.O. Box 9085, Farmington Hills, MI 48333-9085.

Do I need a card? No. Your dentist can verify your eligibility for coverage 24 hours a day, seven days a week, by checking our online Dental Office Toolkit or by calling our DASI (Delta’s Automated Service Inquiry) system. However, to help with the transition, a reference card will be mailed to your home address prior to July 1, 2010. The card may be useful to you and your dental office personnel.

Still have questions? Call our friendly customer service representatives at 800.228.5088 or 614.508.2255 or go online at www.benefitstrust.org

Updated April 2010