If your employer participates in the dental plans offered through OSEEGIB, employees are eligible to enroll if they have health insurance through OSEEGIB or provide you with proof of other group health insurance. (See Eligibility and Enrollment )
The dental plans offered through OSEEGIB provide benefits for preventive, basic, and major care, and orthodontia treatment. Benefits are subject to each plan’s rules and cost-sharing features such as copays, deductibles, and coinsurance.
Be aware that all plans have certain benefit limitations and plan year maximums. Charges that exceed the annual maximum may be handled differently by each dental plan. Some plans also apply a waiting period for orthodontia benefits. Check with each plan for benefit details.
All the dental plans offered through OSEEGIB are available statewide, although provider access may be limited in some areas. Encourage employees to check each plan’s list of network providers before selecting a dental plan.
For Plan Year 2012, there are eight dental plan options available to employees:
Assurant Freedom Preferred
Assurant Heritage Plus with SBA (Prepaid)
Assurant Heritage Secure (Prepaid)
CIGNA Dental Care Plan (Prepaid)
Delta Dental PPO
Delta Dental Premier
Delta Dental PPO - Choice
HealthChoice Dental Plan
When an employee enrolls in one of the prepaid dental plans, they must designate a Primary Care Dentist (PCD) or one is assigned to them. The employee’s first point-of-contact when seeking dental care is their PCD. The PCD is responsible for coordinating all of the employee’s dental care including authorizing visits to a dental specialist. Failure to obtain authorization from their PCD can result
in denial of claims.
Coordination of Benefits (COB)
Coordination of Benefits is discussed in the Health Insurance section. Be aware that the same rules and processes apply to COB when a member has two dental insurance carriers.
All the dental plans offered through OSEEGIB coordinate benefits with other group dental plans.
Choosing a Dental Provider
When an employee enrolls in a prepaid dental plan (DMO), they should designate a Primary Care Dentist (PCD). If they do not select a PCD, one is assigned to them. The first point-of-contact when seeking dental care is the PCD, who is responsible for coordinating all dental care including authorizing visits to a specialist. Failure to obtain authorization from the PCD can result in the denial of claims.
Employees should confirm their provider or facility participates in their plan’s provider network when scheduling services. The most up-to-date list of network providers is available on each plan’s website or employees can contact the plan directly. (See Contact Information for Dental Insurance ) If the employee decides to use a non-Network provider, their out-of-pocket costs can be substantially higher.
Each plan issues identification cards to its members. Note that providers and facilities often require a copy of the employee’s plan ID card and drivers license or photo ID when they receive dental care.
More Information About Dental Insurance
The dental plans do not include prescription drug benefits. Dental prescriptions, written by licensed dentists, are covered under the prescription drug benefits of the employee’s health plan. For more information, the member should contact their plan directly.
Contact Information for Dental Insurance