So, why does the JHMB have two dental plans available? The answer: To provide the greatest amount of flexibility in choice of coverage, because one size definitely does not fit all.
Currently, the JHMB offers dental coverage through Delta Dental, and Pacific Union Dental (United Healthcare Dental). While both plans are designed to offer appropriate care at an affordable premium, there are differences in the way each plan operates.
Delta Dental operates in a way that’s similar to your health insurance. The covered individual chooses their dentist, files a claim, and has approved treatments and expenses covered under a sliding scale, where Delta pays 70 percent of the usual and customary expenses of covered procedures during the first year of coverage, with the percentage covered increasing to 80, 90 and 100 percent of usual and customary during the second, third and fourth consecutive years of coverage. This sliding scale is designed both to keep coverage affordable, and to encourage those in the plan to maintain annual visits to their dentist.
Conversely, Pacific Union Dental operates more like an HMO. Under Pacific Union Dental, the covered individual must choose a dentist within the Pacific Union Dental network, and has approved services provided without the need for claim forms, deductibles or maximums. Some services are provided on a co-pay basis, with the covered individual arranging to pay the balance directly through the dentist’s office. But as long as an individual remains enrolled in the Pacific Union plan, their chosen dentist’s office receives a monthly payment from Pacific Union that entitles the covered individual to services.
As with any other dental coverage, each plan carries certain limitations and exclusions. For details on these, consult your Benefits Book or visit the Dental Benefits section of the HealthConnect website.