|
ADVANTAGES OF THE VACE/NEK CHAMBER DENTAL PROGRAM The VACE Insurance Program, in cooperation with the Northeast Kingdom Chamber, recognizes that good dental care is an important part of a well-rounded health program. The VACE Insurance Program has developed several benefit options for your consideration. Through membership in the VACE Insurance Program, employers can include a Northeast Delta Dental Plan as a benefit for their employees and their families. Northeast Delta Dental has a Participating Dentists’ Agreement that requires member dentists to file their individual fees with Northeast Delta Dental. When a claim is submitted, the payment will be based on what the participating dentist charges as the usual fee for that procedure. If the dentist’s fee is higher than Northeast Delta Dental’s allowance, the fee will be reduced, and the patient will not be balance billed. These fees can be audited by their Cost and Quality Assurance Department, assuring that the fees filed are the same fees the dentist charges to all patients. Northeast Delta Dental’s Professional Relations Department is in frequent communication with the dentists.
PARTICIPATING DENTISTS’ NETWORK Participants will get the best value from the program when they receive dental care from one of Northeast Delta Dental’s Participating Dentists: - No Balance Billing: Because participating dentists accept their usual filed fees for service, participants will normally pay less when they visit a participating dentist. - No Claims Processing: Participating dentists will prepare and submit claims to Northeast Delta Dental. - Direct Payment: Northeast Delta Dental pays the dentist directly, so you don’t have to pay the covered amount upfront and wait for a reimbursement check. NON-
PARTICIPATING DENTISTS (Within Maine, N.H. and Vermont) Northeast Delta Dental provides coverage regardless of the patients’ choice of dentists, participating or not. When visiting a non-participating dentist within the tri-state area, the patient may be required to submit the claim to Northeast Delta Dental and pay for the servcies at the time they are provided. Payment for services rendered will be based upon the plan’s allowance for non-participating dentists. The Notification of Benefits and claim payment will go directly to the subsriber. The patiend will be responsible for any remaining balance.
OUT OF TRI-STATE AREA (Outside Maine, N.H. and Vermont) Delta Dental provides coverage for treatment received outside of Maine, New Hampshire, and Vermont. When visiting a dentist outside the area, the patient may be required to submit the claim to Northeast Delta Dental, and pay for the services at the time they are provided. Payment for services rendered will be based upon the lesser of the dentist’s actual submitted charge or an amount equal to a selected percentile of a nationally recognized database in the zip code in which the services were provided. The payment will be made to the dentist unless the claim is marked “Paid,” then the payment will be sent to the subscriber; the patient will be responsible for any remaining balance.
BACKED BY VACE INSURANCE PROGRAM & NORTHEAST DELTA DENTAL When you join the VACE Northeast Delta Dental Plan, you’re backed by two organizations that are renowned for providing businesses such as yours with the very best service available. The VACE Insurance Program is provided by Chamber Benefits, Inc., a subsidiary of the Vermont Association of Chamber of Commerce Executives (VACE), for chambers of commerce in Vermont and the benefit of their employer members and employees. Then, there is Delta Dental - the oldest, largest and most innovative dental plan in the country. The experts at Northeast Delta Dental will administer your program on a day-to-day basis making sure to give you service that is second to none.
MONTHLY RATES: One Person: $40.50 Two Person: $67.50 Three or More Persons: $108.50
DENTAL COVERAGE AVAILABLE: COVERAGE A (*Northeast Delta Dental Pays 100 Percent) Diagnostic: -Evaluations once in a 6-month period -Full mouth/panorex x-rays once in a 3-year period -Bite wing x-rays once each 12-month period -X-rays of individual teeth as necessary Preventative: -Cleanings once in a 6-month period -Flouride once in a 12-month period to age 19 -Space maintainers to age 16 -Sealants for children to age 15 on permanent teeth
COVERAGE B (*Northeast Delta Dental pays 80 percent, after a 6-month waiting period) Restorative: -Fillings Oral Surgery: -Extractions and other surgical procedures Endodontics: -Root-canal therapy Periodontics: -Treatment of gum disease; periodontal prophylaxis (cleaning) Denture Repair: - Repair of removable dentures Emergency treatment
COVERAGE C (*Northeast Delta Dental pays 50 percent after a 12-month waiting period) Prosthodontics: -Removable and fixed partial dentures (bridge), complete denture, rebase and reline (denture), crowns, onlays
COVERAGE D (*Northeast Delta Dental pays 50 percent after a 24-month waiting period; lifetime maximum is $1,000 per patient) - No Deductible - Orthodontics: -Correction of malposed (crooked) teeth for adults and children Lifetime deductible per person/per family (not applied to coverages A&D): $100/#300 Calendar-year maximum per person (coverages A,B and C combined): $1,000 *(Benefit percentages shown are based upon the actual charge submitted to a maximum of the participating dentist’s approved fees, or Northeast Delta Dental’s allowance for non-participating and out-of-tri-state-area dentists. Rates valid through 06/30/05.)
PREDETERMINATION OF BENEFITS Northeast Delta Dental strongly encourages predetermination in procedures involving costly or extensive treatment plans. Although it’s not required, predetermination helps avoid any potential confusion regarding payment and your financial obligation to the dentist.
LITTLE OR NO PAPERWORK When the patient goes to a participating dentist, the identification card is presented. Participating dentists have a supply of claim forms in their offices. The patient supplies certain personal information. The rest of the claim form is completed by the dentist’s office - without charge. The dentist sends the claim to Northeast Delta Dental. The company processes the completed form and pays the dentist directly. The patient receives a Notification of Benefits indicating any obligation to the dentist.
ELIGIBILITY One Person: Employee Only. Two Persons: Employee with one dependent. Three or More Persons: Employee, spouse and all unmarried, dependent children from age 2 to age 19. Dependent coverage ceases at age 19 or at age 25 when the child is attending a degree-granting institute of higher education as a full-time student. Incapacitated children can remain covered regardless of age. All full-time employees, their spouses or a party to a civil union and unmarried dependent children age 2 to age 19 (25 if the dependent child is a full-time student) are eligible to enroll in the program. If an employee chooses to enroll one dependent, all eligible dependents must be enrolled.
WHO CAN JOINMember groups can participate in the VACE Insurance Program sign a joinder agreement and process monthly premium payments to the VACE Insurance Program.
WHO PAYS: HOW AND WHEN Employer Pays: -Any amount of the enrolled employee cost; no minimum employer contribution. Employee Pays: -The entire amount of the employee cost and the entire dependent cost, if applicable, through premium deductions. Premiums are forwarded to VACE Insurance Program monthly.
HOW TO JOIN -Enrollment forms must be completed by each enrolled employee. -Coverage for enrolled employees/dependents must continue until the end of that contract year. Failure to enroll in the beginning of a contract year or after the probationary period results in no coverage until next contract year’s open enrollment, except in the event of a qualified family status change. As the VACE Insurance Program office to define these qualifying events. -The employer may require a probationary period before an employee may join. TO ENROLL
CONTACT: Darcie McCann, Executive Director Northeast Kingdom Chamber 51 Depot Square-Ste. 3 St. Johnsbury, VT 05851 802-748-3678 fax: 802-748-0731 director@nekchamber.com
|
