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New for 2010! Delta Dental "You" Choose Plan

Your UBT Trustees have selected Delta Dental of Ohio as your dental carrier effective July 1, 2010. You will continue to receive the same high quality benefits you’ve come to expect from UBT. Through a competitive bid process and evaluation of several carriers, UBT Trustees have chosen Delta Dental of Ohio to provide dental benefits to UBT members as a result of increased provider access and savings.

You will be covered under one plan, the UBT Dental Plan and the dentist “You” choose will determine your savings. The UBT Dental Plan covers diagnostic and preventative services at 100%, and no deductible is required. Out-of-pocket costs vary depending on the provider you choose.
You must meet the annual deductible of $25 per person, for class 2 and 3 services, before benefits are paid. Benefits will be paid up to the maximum annual benefit amount of $1500 per person per plan year.

“You” choose options

  • Delta Preferred PPO providers offer the highest level of savings and cannot balance-bill you for additional payment for the services you received. That means no additional out of pocket expenses.
  • Delta Premier providers are in the secondary network. While you receive a more modest savings compared to the PPO, you will have many more dentists to choose from than the PPO. You cannot be balance-billed for the difference between the dental charge and the allowed amount.
  • Non-participating providers will balance-bill you for any amount that exceeds Delta Dental’s allowed amount. They may ask you to pay the full amount up front and may have you submit your claim information to receive re-imbursement.

 
Class 1 Benefit (see comparison chart)
Charge for Service $100
Delta Dental PPO Fee Schedule $70
Delta Dental Premier Maximum Approved Fee $90
Non-participating Maximum Allowed $87
What happens if you go to a:
Delta Dental PPO Dentist
Delta Dental Premier Dentist
Non-participating Provider
Benefit Level
100%
100%
100%
Plan pays
$70
$90
$87
Member pays
$0
$0
$13
Class 2 and 3 Benefits (see comparison chart)
Billed Charge $500
Delta Dental PPO Fee Schedule $350
Delta Dental Premier Maximum Approved Fee $450
Non-participating Maximum Allowed $420
What happens if you go to a: Delta Dental PPO Dentist Delta Dental Premier Dentist Non-participating Provider
Benefit Level 100% 65% 65%
Plan pays $350 $292.50 $273
Member pays $0 $157.50 $227
 

 

Everyone receives the same plan. How you use it is your choice. You do not need to select a coverage option--your option is determined by the dentist you choose. It is important to tell your current dentist that your dental carrier will change to Delta Dental of Ohio effective July 1, 2010. Ask your current dentist at which level he/she will participate. If you want to find a provider, click here.

For any services rendered prior to July 1, 2010, your claims must be submitted to Met Life for payment of benefits. For services rendered July 1st and after, remind your dentist to submit claims to:

Delta Dental
P.O. Box 9085 • Farmington Hills, MI 48333-9085.

For a claim form, click here.

Finding a Participating Dentist

To find the names of participating dentists near you, call the Delta Dental’s customer service department toll-free at (877) 334-5008. The 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 participating dentists. You can also go directly to www.deltadentaloh.com.

Still have questions?

Contact UBT customer service toll-free at 800.228.5088 or local 614.508.2255

Compare the two UBT Delta Dental networks here.

FAQ

Plan Booklet-Certificate

Page last updated on July 6, 2010