Att B - Benefit Summary Comparison of Dental Plans.pdf
PDF 14 KB Posted
- Attached to
- RFP #2021-04 Dental Services
- Solicitation number
- 2021 - 04
- Issued by
- Wisconsin
About this file
This is a Benefit Summary Comparison document prepared by Dunn County, Wisconsin, outlining dental insurance plan options for employees and their families in response to RFP #2021-04 Dental Services. The document compares two dental plan structures: a Free-Standing Indemnity plan and a DentaCare HMO plan (Network Providers Only). The comparison addresses coverage for diagnostic services, preventative care, restorations, endodontics, periodontics, oral surgery, prosthetics, and orthodontics. Key distinctions between the plans include the Free-Standing Indemnity plan's $1,000 maximum allowance per person per calendar year with no deductible, while the DentaCare HMO plan offers no dollar maximum and also carries no deductible. Both plans provide 100% coverage of usual and customary fees for diagnostic and preventative services, though the DentaCare HMO plan removes age limitations on fluoride application and includes coverage for regular plaque control programs not offered under the Indemnity plan.
The document indicates that coverage specifics vary significantly between plan types for major services. For restorations, endodontics, and periodontics, the Free-Standing Indemnity plan covers 100% of usual and customary fees, while the DentaCare HMO plan provides full coverage without specified limitations. Prosthetics coverage differs markedly, with the Indemnity plan covering only 50% of initial costs and requiring replacement authorization through the provider, whereas the DentaCare HMO plan covers initial prosthetics with replacement procedures handled through the provider. Orthodontic coverage is limited under the Indemnity plan to dependent children under age 19 with a lifetime maximum payment of $800, while the DentaCare HMO plan extends coverage to individuals of all ages with no stated age restrictions. The document notes that all statements are subject to the terms and conditions of Anthem contracts and employees are responsible for reviewing complete summary plan descriptions.
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Text version
Benefits Free-Standing - Indemnity DentaCare HMO
(Network Providers Only)
Maximum Allowance Usual & Customary (U&C) fees of the dentist up to $1,000 per person per calendar year.
No dollar maximum
Deductible No Deductible No Deductible
Diagnostic - dental x-rays 100% of U&C. Full mouth once every 36 months. Bitewings, limited to 2 in a calendar year.
Covered - No Limit
Oral Examinations 100% of U&C. Limited to a total of
2 in a calendar year.
Covered - No Limit
Preventative
- Application of fluoride 100% of U&C for members under age 19 years
Covered - No age limit
- Prophylaxis (cleaning of teeth) 100% of U&C - limited to a total of
2 in a calendar year.
Covered - No Limit
- Regular plaque control program
Not Covered Covered
Restorations
- Regular fillings (amalgams, silicate, acrylic, synthetic, porcelain, composite)
100% of U&C Covered
Endodontics
(root canal treatment & pulpal therapy
100% of U&C Covered
Periodontics
(Treatment of diseases of gums and tissues of the mouth
100% of U&C Covered
Oral surgery including simple extractions
100% of U&C. Will not duplicate health insurance surgical-medical benefits.
Covered. Will not duplicate health insurance surgical-medical benefits
Prosthetics
(Bridges, partials, dentures) 50% of U&C Initial Covered - Replacements
(call provider)
Orthodontics (Braces) Plan pays 50% of U&C to a lifetime maximum payment of
$800. Limited to dependent children under age 19 years.
Patient pays 50% of the fee up to a maximum payment by the patient of $695. No age limit.
The statement in this comparison are intended for general information and are subject to the terms and conditions of the Anthem contracts. Employees are responsible for reading all dental summary plan descriptions to determine the benefit coverage.
Basic Comparison between Dental Benefits (Free-Standing-Indemnity and DentaCare HMO)
V:\Administration\Orientation Forms\Dental Insurance Orientation\Comparison of Dental Plans
V:\Administration\Orientation Forms\Dental Insurance Orientation\Comparison of Dental Plans
File details come from the government source that posted it. Updated .