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PEBB Dental FAQs

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

Through Delta Dental's national network of providers, PEBB members who reside out of state have access to more than 155,000 in-network Delta Dental Premier providers and more than 114,000 PPO in-network providers nationwide.

How does an incentive dental plan work (Full Time PEBB Delta Dental PPO Plan)?

Under an incentive dental plan, benefits start at 80% for in-network benefits 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 PPO dentist at least once during the previous plan year. If the member did not visit a PPO dentist in the previous plan year there will be a 10% reduction in payment in the new plan year. Payment will never fall below 80%for in-network benefits.

Please note, this plan includes incentive-based benefits for restorative (basic) services only.

How often are cleanings allowed?

Prophylaxis (cleaning) or periodontal maintenance is covered twice per year.

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.

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 PEBB members move from a constant plan (Full Time or Part Time Premier Plan) to an incentive plan (Full Time PPO Plan) their incentive level starts at 80% for in-network benefits, regardless of their original date of hire.

If a member has dual Delta Dental coverage under PEBB, does the maximum benefit double, as well? For example, if two members (husband and wife) have the Full Time PPO Plan, is their total maximum of $3,500 per member per plan year in lieu of the $1,750 per member per plan year?

If a member has dual Delta Dental coverage under PEBB with a plan maximum (e.g., PPO Plan with $1,750 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 ($1,750 has been paid out), then the secondary plan will pay, as if it is primary, until it has also met the $1,750 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 80% incentive level under both plans and has the full maximum benefit ($1,750) 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.

If members have dual Delta Dental coverage under PEBB through Delta Dental and their dentist charges more than the Maximum Plan Allowance, will the other policy pick up the remainder of the charges through coordination of benefits?

If a member has dual Delta Dental coverage under PEBB with a plan maximum (e.g., PPO Plan with $1,750 plan-year maximum), the primary plan will pay first. The secondary plan will pick up balances on allowable expenses.

When a member visits a dentist who is in the Delta Dental PremierĀ® Network or the Delta Dental PPO(SM) 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 PEBB, 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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