The Pebb Program’s Annual Open Enrollment
From November 1 to 30 each year, you can make changes to your PEBB Program account that will take effect January 1 of the following year.
During open enrollment you can:
- Change your medical or dental plans.
- Enroll or remove eligible dependents from your PEBB medical or dental plan.
Note: If you enroll a dependent, you may need to provide proof of the dependents eligibility with your enrollment form before they can be enrolled. Visit Dependent verification to find a list of acceptable dependent verification documents.
Dual Dental Coverage: Can I Have Two Dental Insurance Plans
What is dual dental coverage?
If you are covered under two different dental insurance plans, then you have dual dental coverage. Dual dental coverage typically occurs when you have two jobs that each provide dental benefits, or you are covered by your spouses dental plan in addition to your own.
Having dual coverage doesn’t double your benefits, but you might pay less for dental procedures than if you were covered under just one plan because treatment costs may be shared between your two carriers up to 100%.1 All dental plans will have contractual language to determine how coordination of benefits will be handled between the two plans and how it could impact your out-of-pocket costs. Because state laws and regulations play a substantial role in determining how insurance benefit coordination occurs, there may be variations in how they work in your state, so it is best to check with your insurers to find out exactly how COB works for you.
Some COB provisions limit what a plan will cover, while others can involve a detailed process to follow. COB provisions may also depend on individual state laws and regulations, and other variables that vary by state.
In this article, well explain how dual coverage works, along with some related terminology and limitations to be aware of.
How does dual dental coverage and COB work?
Will I receive twice the benefits?
Heres an example of how these limitations could work:
How do I know which is my primary carrier?
Will The Aca Change Your Dental Insurance
Posted November 18, 2013
The Affordable Care Act launches in January 2014. Do you know whether it will affect your dental and vision benefits?
Health care reform and the ACA will change the face of medical coverage for many Americans.
But heres the good news: You do not need to make any changes to your dental and/or vision plan, and you can keep your current benefits at least until your 2014 renewal.
As a dental and vision insurance carrier, Ameritas has tracked health care reform since its beginning. And we want to make sure you have the facts about dental and vision coverage in relation to the ACA, so you can maintain the coverage you and your employees need.
Small employer and individual requirements
Beginning Jan. 1, 2014, insurers are required to offer Essential Health Benefit packages to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. EHB packages include pediatric dental and vision, typically up to age 19. In the small employer market, medical carriers must include pediatric vision in their plans. Pediatric dental and family dental coverage can be sold in separate dental policies in most states in or out of exchanges.
Individual mandateAll consumers, with a few exceptions, are required to have medical coverage in 2014, regardless of the size of their employer. If they dont have Minimum Essential Coverage, they will be subject to a fine.
Other key points to know
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What To Do If A Dental Procedure Is Not Covered
If a dental procedure is required but is excluded due to the dental insurance waiting period, ask your dentist if there is anything they can do to help you manage the cost. Sometimes the dentist may consider giving you a discount or consider payment plans. Waiting for the waiting period to be over to do major dental work may not be a good idea. Your dentist will be able to give you their professional opinion. However, if you do the math, most coverages that are limited by a dental insurance waiting period may only be covered up to 50%. If you let a problem get worse over several months to wait it out may cost you a lot more than your dental insurance would even be paying out. Your health has to take priority.
Also, remember that different dental benefit plans also include maximum amounts payable and deductibles so you will want to check these numbers out as well to understand if the waiting period is costing you anything.
What Does Dental Insurance For Seniors Over 65 Cover
Dental plans that best meet seniors needs cover a plethora of services. The level of coverage will depend on the type of service provided and the benefit level you have chosen . Here are some examples of services that can be covered:
- Two annual oral evaluations/preventive exams
- Oral surgery, which can include extraction of a tooth
If you select a plan with more comprehensive coverage, the following may be covered:
These are simply examples of services covered by dental insurance plans for seniors over 65. Be sure to check your dental policy to see what, and how much, is covered.
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What Are My Payment Options
Delta Dental of Kansas has two payment options.
How Do I Add My Spouse Partner Or Dependents To My Plan
You can add dependents during the initial sign-up process. If you have a dental plan through your employer, well get information about eligible family members from them. Please follow the procedures at your employer to add, delete or change information about family and dependents. Please contact our Customer Service directly If you have a DeltaCare USA plan or coverage through AARP.
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How Much Does Dental Insurance Cost
Dental insurance costs can range from £70 to £300 a year, with the amount varying between different insurers and policies.
Many offer different levels of cover from basic routine care up to extensive treatment plans. So you can choose how much you want to spend and the amount of cover you want.
For example, a cheaper policy might pay out 50% of treatment you receive and/or have a lower benefit limit per condition per year. For example, up to £500 for root canal work in one year.
Even if you have cover, youll still have to pay for some treatment and theres a limit on how much you can claim back for each treatment plan. For example, you might be paid a percentage from 50 to 70% of the fee charged by your dentist for remedial dental treatment. Although some policies refund 100% of the fee for NHS treatment.
How To Increase Your Annual Maximum Benefit
All three plans have an Annual Maximum benefit. The Annual Maximum for the PPO plan is $1,500 on Plan A is $1,250 and, on Plan B is $1,000. If you reach the Annual Maximum benefit, Ameritas will not reimburse any additional services for the remainder of the calendar year. However, if you have Dental Rewards carryover, those accumulated dollars can go towards additional covered benefits. Dental plan members who have at least one covered procedure during the calendar year and have total paid claims under $500 in the calendar year will automatically carryover or bank $250 Dental Rewards dollars. If a member visits a participating network provider, an additional $100 PPO Bonus is added to the carryover benefit. A member can continue to increase the Dental Rewards carryover each year until the total accumulation reaches $1,000 in carryover benefit. This Dental Rewards carryover is in addition to the Annual Maximum. Any Dental Rewards dollars accumulated will automatically be used if the member has approved claims that go beyond their Annual Maximum benefit. Only these approved claims will be considered for benefit reimbursement through accumulated carryover dollars. Please note, a member must visit the dentist once each calendar year for a covered procedure in order to earn and maintain any Dental Rewards carryover.
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Learn More About Dental Implants With Hiossen Implant
As one of the top five dental implant companies worldwide, Hiossen Implant provides safe and innovative implant solutions. Through extensive testing, research and expert input, Hiossen has created high-quality implants that both our clinicians and patients trust. With Hiossen Implant, you can reap the benefits from our commitment to shorter healing times and convenient aesthetic solutions.
Contact us today to learn more about our dental implants or find a Hiossen Implant location near you.
What Plans Cover Orthodontics
In some cases, private individual and family plans offer dental insurance for orthodontic care. Employer-sponsored dental insurance plans sometimes contain this optional coverage. If you discover that your current policy does not cover orthodontics, you can supplement it with a more inclusive dental plan.
A number of dental plans may include the following orthodontic services for adults and children:
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What About Dental Discount Plans
Discount plans are also sold by private companies, but they are not insurance plans. There are no copays, coinsurance, or deductible amounts. That also means there are no pre-negotiated rates or free yearly checkups and cleanings. A participating dentist simply agrees to offer discounts for certain medical services. Then, seniors who choose discount plans will pay their dentist directly for the cost of services .
Depending on the plan, discount plans can be a good alternative for senior dental insurance because:
- They are inexpensive.
Compare Medicare Advantage Dental Plans
Using Medicares Find a Medicare Plan tool, you can log in without an account, choose a Medicare Advantage Plan, type in your ZIP code, and follow the simple instructions to get a list of the available plans. The Plan Details button helps you learn more about the coverage offered, such as preventative dental or comprehensive dental .
Getting To Know Your New Plan
To find out if your employers new dental insurance coverage will meet your needs, its important first to narrow down what exactly those needs are. To help with this process, you can ask yourself this series of questions straight from the American Dental Association :
According to the ADA, your coverage summary should include covered services, reimbursement levels, estimated enrollee cost share , limitations, and exceptions.
If the new insurance information you get doesnt answer these questions, dont be afraid to reach out to your employer to clarify.
Heres another good thing to keep in mind:
Your dental care provider knows your teeth better than anyone. So, theyre one of the best people to ask about what your dental needs are and will be over the course of the following year.
Have a chat with your San Diego dentist if youre unsure of what benefits you might need.
Late Entrant Restrictions On Benefits For 2021
If you and/or your dependent are not currently enrolled for dental coverage through Duke and enroll for 2021, you and/or your dependent will be considered a “late entrant.” As a “late entrant” your benefits during 2021 will be limited to preventive services: two preventive routine care exams , two prophylaxis cleanings, and for children under age 19, one fluoride application. No other dental or orthodontia procedures or services will be covered during the first 12 months, if a member is enrolled as a late entrant.
Periodontal procedures, including maintenance/ cleanings, would not be covered during this 12-month period.
Once you have been enrolled in a Duke dental plan for at least 12 months, the plan will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment .
This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke plan,
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption, or
- if you add a child during an open enrollment period prior to his/her second birthday.
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Does Dental Insurance Cover Braces And Orthodontist Services
Major medical insurance plans do nottypically include dental coverage. It is most often a supplemental plan thatyou need to purchase separately.
When it comes to braces andorthodontics, it is important to know what your dental insurance covers andwhat different coverage exists for both children and adults.
If you have children age 18 or younger, insurance companies must offer an option to purchase dental insurance that meets the criteria of the Affordable Care Act when you are purchasing health insurance. But whether or not you purchase it is up to you. There is also no ACA tax penalty if your children dont have dental insurance.
Dental policies for children differ from state to state and cover different dental services. For example, some plans pay the entire cost for topical fluoride, sealants, and preventive care, but the patients parents are responsible for a portion of the cost of fillings. Other dental plans may cover the full cost of preventive care services provided by one of the plans participating dentists, and the insured person pays a portion of the cost of all other covered dental services.
What You Need To Know About Dental Insurance
- Dental insurance policies cover routine check-ups, as well as the costs of all dental work. This includes dental accidents and emergencies.
- You can often have the work done at either an NHS practice or a private clinic.
- If you use an NHS dentist, youre more likely to get back 100% of the cost of your treatment.
- If you cant see an NHS dentist, youll only be paid back a percentage of your treatment costs.
- You pay the dentist first, then claim back your money. You can normally only start to claim between one and three months after you buy the insurance.
- There are usually annual limits on how much you can claim for certain treatments.
- If you havent been to the dentist in the past 12 months, your policy might not pay for treatment identified at your first check-up.
- Cosmetic dental work, such as teeth whitening, isnt generally covered.
- Most policies have an age range that starts from age 18 although some start at age six.
- Some policies offer a no-claims discount. So the cost of your premium will increase if you make a claim for anything other than a standard check-up.
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Consider A Dental Savings Plan
Dental discount plans enable you to save 10%-60% on your dental care. There are plans that cover all treatments from braces to dentures. There are no annual spending caps, waiting periods, approval process or restrictions on pre-existing conditions.
Dental savings plans are very affordable. The plans available on dentalplans.com range from $79.95-$199.95 annually. Plus, many of DentalPlans.com dental savings plans include additional free bonus benefits too, such as savings on vision and hearing care, prescriptions, and other wellness services. Select plans even include a bundle of health and wellness services which range from telemedicine free consultations with local doctors who can diagnose and treat common ailments , discounts on chiropractic, alternative medicine and fitness centers, and savings on lab work and medical diagnostic services.
Visit dentalplans.com to find out about how dental savings plans can help make quality dental care affordable.
Dental Information Center
What Do I Do If I Have Problems With My Dentist Or The Care I’ve Received
If youre having minor issues with your dentist, we encourage you to first communicate directly with your dentist to resolve the issue. If you cant resolve the issue together, you can file an online grievance report or contact our Customer Service.
If youre unhappy with the care youve received, we can review your care or arrange for you to be examined by a consulting dentist in your area. If we find that your care wasnt satisfactory, we will ensure that your original dentist either fixes the issue at no additional cost or else grants you a refund.
If youve been the victim of fraud or are suspicious of fraud, you can complete our online Fraud Report Form or call our toll-free anonymous hotline: 800-526-1852.
If youve been the victim of a serious crime, please dont hesitate to contact the police.
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How To Cancel Your 2022 Insurance Plan Without Replacing It
- If you’ll be automatically enrolled for 2022:Log in, select your 2021 application, select “My Plans & Programs,” then select “Stop Coverage for 2021.” Your coverage will be canceled for 2021 and 2022.
- If you wont be automatically enrolled:Log in and select your 2022 application. Choose “My Plans & Programs,” and click the red “End All Coverage” button.