Dental Plan Questions

1.	What are the differences between a Premier and a non-network dentist? Delta Dental's benefits are available for both in-network and out-of-network dental providers. If you see a dental provider in the Delta PPO network, the discounts to you are greatest, though the network is smaller. The Delta Premier network contains most dental providers in Oklahoma and 80% of dentists nationwide. Services from dental providers in the Premier network are less discounted than those from the PPO network. The major benefit of using the Delta Premier Network instead of non-participating dental providers is that providers in the Premier Network have agreed not to balance-bill you. This means they will not charge you the difference between what Delta Dental pays them and what they normally might charge. You can expect significantly higher out-of-pocket expenses if you use a non-participating provider. Get more information at http://www.hr.ou.edu/benefits/Delta.asp.
2.	Why are some dentists on the PPO network and not on the Premier network? Choosing to participate in a particular network is a financial decision made by the dentist.
3.	Can you link the dental deductibles for two employees? No. Dental deductibles cannot be linked at this time.
4.	Is anesthesia covered during an office visit? Yes.
5.	How can an employee determine the cost of a procedure and what their out of pocket expense will be in advance of the procedure? Ask the dental provider to submit a pre-determination request to Delta Dental.
6.	If a dentist is not in the network, can an employee receive a pre-determination? Yes. The dental provider should ask Delta Dental for a pre-determination.
7.	What is the turn-around time on a pre-determination request? Two weeks.
8.	Is there is a charge for pre-determination requests? No.
9.	What is the maximum number of cleanings covered in a year? Two cleanings are covered each year.
10.	What is the restriction for full mouth x-rays? Once every five years.
11.	Are there more restrictions on the Premier or PPO networks? No, there is no difference in the restrictions between the networks.
12.	How can members view coverage and explanations of benefits (EOBs) on-line? Members can login to Spotlight at www.deltadentalok.org/client/ou/ to view their deductible, plan coverage, EOBs, and remaining annual maximum amounts. They can also request new ID cards and print temporary ID cards.
13.	Can an employee go on the web and view their dependents’ balances and information? Yes, only for minor children.
14.	Where can employees locate a list of Norman orthodontists? www.deltadentalok.org/client/ou/
15.	At what age are students no longer covered on the dental plans? Age 18 unless a full time student, then age 25 if full-time student.
16.	Is the OU Dental and Medical School in the network? They are in the Premier network.