The County offers two dental plans to meet your dental needs:
The dental insurance is a pre-tax plan; elections are irrevocable for the plan year and cannot be changed unless the change is due to a relevant qualifying event.
DHMO – HUMANA/COMPBENEFITS
Dental DHMO plans are like health HMOs. All services must be obtained from a participating dentist or specialist. No referral is needed for specialty services. Members are required to select a Primary Care Dentist (PCD)/Facility. Each family member can select a different PCD/Facility. PCD’s can be changed on a monthly basis; however, the change must be made by the 15th of the month to be effective the first of the following month. Dental services are based on a Discounted Fee Schedule (see complete schedule in Provider booklet). The Discounted Fee Schedule applies to services provided by your primary dentist and specialists. Note: not all ADA (American Dental Association) codes are covered under the DHMO plan. Services received for ADA codes not covered under the Discounted Fee Schedule are provided at a 25 percent discount. This plan does not have a "Missing Tooth" exclusion. See Provider material for more details.
How to use this plan:
When making your dental appointment, verify that your dentist is participating and that you, or your dependent, are assigned to their office. When visiting your participating DHMO dentist give them your ID card to identify yourself as a "Humana/CompBenefits" dental member. You will be responsible for the copay for the service(s) you receive. Services for ADA codes not shown on your benefit schedule will be charged to you at the dentist’s Usual and Customary rate less a 25 percent discount. To find participating dentists in your area, go to www.compbenefits.com/custom/broward and select CS150P Providers or log into your secure account at www.mycompbenefits.com.
Website services include:
HIGH PPO PLAN - STANDARD THROUGH THE AMERITAS DENTAL NETWORK
The High PPO Plan dental network has an extensive nationwide dental network with numerous dentists, including Specialists. This plan also includes an out-of-network benefit and reimburses at one of the highest usual and customary percentiles, which means less out-of-pocket cost to you. If you utilize a "participating" network dentist your savings are even greater because the participating network dentist must charge a negotiated contract rate.
The annual maximum benefit is: $1,500 per person in-network and $1,000 per person out-of-network. There is a $50 annual deductible (waived on Preventive) per person, maximum three family members, which satisfies both your in-network and out-of-network deductible. If you reach your annual maximum, you will also be eligible to receive additional services at discounted rates.
MAX BUILDER FEATURE
The High PPO plan offers a unique feature that allows members to carry over some of their benefit into the next plan year based on plan usage:
Member must go to the dentist and submit at least one dental claim during the plan year
Dental benefits paid during the plan year were $500 or less
If both 1 and 2 are met, $250 carries over and is added to the next year’s maximum. The maximum carryover that can accumulate is $1,000. As an added benefit, if you meet 1 and 2, and if you receive services from a Participating Dentist during the year, you will receive an additional $100 for a total carry over for the year of $350. Note: if you do not submit a dental claim during a benefit year, the accumulated carry over amount will be lost. See Provider’s material for more information.
ORTHODONTIC COVERAGE (MUST BE BANDED BY 17TH BIRTHDAY)
Orthodontic coverage is provided at 50 percent up to a maximum plan limit of $1,000 per lifetime. Orthodontia claims are paid differently than regular dental claims in that they are paid/reimbursed on a quarterly basis up to a maximum of a 24-month period with the first payment starting around the third month of treatment.
MISSING TOOTH BENEFIT
Currently enrolled in the High PPO plan
If you have a tooth extracted while covered under High PPO dental plan, replacement must occur within six (6) months from the date of the extraction.
New enrollment in the High PPO dental plan
Any tooth extracted before becoming covered under the High PPO dental plan is not eligible for reimbursement to replace the tooth.
See Provider’s material for more information on policy exclusions and limitations.
How to use this plan:
When visiting your dentist, (in-network or out-of-network), give them your ID card to identify yourself as a "Standard/Ameritas" PPO dental member. A "participating" network dentist will bill the dental provider for reimbursement up to their negotiated contract rate; the dentist will then bill the difference to you. (Most out-of-network dentists will also bill your dental provider, but you must request this service; otherwise you pay the bill and the dental provider reimburses you the allowable amount based on your plan when you submit the claim). To find participating dentists/specialists in your area for the High PPO dental Plan, visit: www.standard.com/services/ppo_providers or log onto your secure account at www.standard.com/services.
Carefully review the dental plan benefit charts in each of the dental carrier’s enrollment packets (DHMO CS150P, and High PPO Plan). You are encouraged to read the information provided by each carrier, as plan selection is irrevocable and cannot be changed after election. If you have questions, please call the carrier’s Customer Service number located on the inside cover of this book.
Be an educated consumer! Ask your dentist to file a pre-treatment estimate with your insurance carrier for services expected to be more than $200. When the pre-treatment estimate is processed prior to services being rendered, both the member and the provider receive a copy indicating to both parties the exact amount of benefits payable to the dentist and the exact amount the member will have to pay out-of-pocket.
NOTE: Pediatric dentists are considered specialists under the Standard High PPO plans and, in most cases, they will charge specialists fees for all services.