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OEBB

Dental benefits

What are the dental benefits when traveling or for dependents residing outside the service area?

Through Delta Dental’s national network of providers, OEBB members who reside out of state have access to more than 156,000 in-network Delta Dental Premier providers and more than 112,00 PPO in-network providers nationwide.

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How does an incentive dental plan work (OEBB Plans 1 and 5)?

Under an incentive dental plan, benefits start at 70% during the first plan year of coverage. Payments increase by 10% in each subsequent plan year (up to a maximum benefit of 100%) provided the member has visited the dentist at least once during the previous plan year. Failure to visit a dentist in the previous plan year will cause a 10% reduction in payment in the new plan year. Payment will never fall below 70%.

Please note, OEBB Plan 5 includes incentive-based benefits for preventative and restorative services only.

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How often are cleanings allowed?

Prophylaxis (cleaning) or periodontal maintenance is covered once in any six-month period.

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Do OEBB members have the Oral Health, Total Health benefit?

Yes. Members can contact Delta Dental Customer Service for enrollment information, but:

  • Diabetic members enrolled in the Oral Health, Total Health program are allowed a total of four prophylaxes or periodontal maintenance sessions in a benefit year.
  • Pregnant women in their third trimester may be eligible for an additional cleaning.

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Is there a deductible on the dental plan?

Yes. There is a $50 deductible on all Delta Dental plans. The deductible is waived for preventive services.

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If a member moves from one incentive plan to another incentive plan, will the incentive level follow them?

Yes. The incentive level follows between plans as long as the lapse in coverage is 31 days or less. This means that the plan will give the incentive credit and will carry-over the annual maximum and deductible for members transferring from one incentive group to another incentive group within OEBB.

Members who renew their eligibility after 31 days from their prior coverage start at 70% incentive level and will receive a new annual maximum and deductible.

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If a member moves from a constant plan to an incentive plan, will the incentive level follow them based on the dental services they received?

No. If current OEBB members move from a constant plan (Plan 6 or the Exclusive PPO plan) to an incentive plan (Plans 1 or 5) their incentive level starts at 70%, regardless of their original date of hire.

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How is the incentive level affected if member has a lapse (break) in coverage of more than 31 days?

If a member has a lapse (break) in coverage of more than 31 days, the incentive level will restart at 70%.

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If a member has dual Delta Dental coverage under OEBB, does the maximum benefit double, as well? For example, if two members (husband and wife) have dental Plan 5, is their total maximum of $3,400 per member per plan year in lieu of the $1,700 per member per plan year?

If a member has dual Delta Dental coverage under OEBB with a plan maximum (e.g., dental plan 5 with $1,700 plan-year maximum), the primary plan will pay first. The secondary plan will pick up balances on allowable expenses.

Once members have met their maximum on the primary plan ($1,700 has been paid out), then the secondary plan will pay, as if it is primary, until it has also met the $1,700 maximum (dollars paid as secondary, prior to the primary maximum being met, also apply toward the secondary $1,700 maximum).

Example:

The member is at the 70% incentive level under both plans and has the full maximum benefit ($1,700) available under both plans. The member has a cleaning by an in network provider and there are no prior cleanings submitted to Delta Dental within the frequency limit. The provider’s charge is $100 for the cleaning and the charge is within the maximum plan allowance. The primary plan would issue a benefit of $70 and then the secondary plan would coordinate benefits and issue a benefit of $30.

The member will have used $70 of their maximum under their primary plan and $30 under the secondary plan.

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If members have dual Delta Dental coverage under OEBB through Delta Dental and their dentist charges more than the usual and customary allowable, will the other policy pick up the remainder of the charges through coordination of benefits?

When a member visits a dentist that is in the Delta Dental premier network, the member will not be billed for charges over the contracted fees. As a Delta Dental participating provider, the provider will write off the amount that is billed over the contract allowance.

Delta Dental, as the secondary plan, will pay up to the highest allowable charge not to exceed the billed amount. If a husband and wife both have Delta Dental coverage under OEBB, the allowed amount will be the same for both plans. If there is a charge over the allowed amount, the members would still be responsible for the extra charge.

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