2012-038 Human Resources - Delta Dental Claims & Administrative fees

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- Porcelain and resin facings on crowns and onlays are Covered Services on posterior teeth. - Porcelain and resin facings on bridges are Covered Services on posterior teeth. - Composite resin (white) restorations are optional treatment on posterior teeth. - People with certain high-risk medical conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. Enrollees can receive expert dental care when they are outside of the United States through our Passport Dental program. Passport Dental gives our enrollees access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help them schedule care. Delta Dental coverage outside of the United States is the same as Delta Dental coverage within the United States. Access to the Passport Dental program is offered through an agreement with a third party vendor, and it may not be available if that agreement terminates. H. Maximum Payment: $1,200 per person total per calendar year on all services except orthodontics. $2,000 per person total per lifetime on orthodontic services. Rate(s): Administrative Services fee: Composite -$2.80 per month per Subscriber This rate is contingent upon the enrollment of a minimum of 75 percent of the eligible members of the defined group and their eligible dependents with 50 percent of the cost paid by the Contractor. In addition to the Administrative Service Fee, the Contractor agrees to transfer to Delta Dental by electronic funds transfer (EFT) the amount of claims paid during the previous week. Invoices will be submitted to the Contractor on Monday of each week for the amount of claims paid during the previous week. The Contractor will transfer this amount to Delta Dental by the end of the following working day. October 25, 2011