Dental Plan - Human Resources at Ohio State

Dental Plan

COVID-19 Updates
See Employment-Related FAQs Specific to COVID-19 for updated benefits information.

All of the benefits available to you reflect Ohio State’s commitment to providing high-quality, affordable plans and represent a significant component of your total rewards for working at Ohio State.

The Dental Plan provides coverage for many dental services that you and your eligible dependents may need. The plan offers both network or out-of-network coverage.

Delta Dental of Ohio provides national network coverage through two networks: Delta Dental PPO and Delta Premier. You receive greater benefit coverage when you use a provider who participates in the Delta Dental PPO network.

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Dental Plan Information

Effective Jan. 1 – Dec. 31, 2020

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Covered Services Delta Dental PPO Network (includes OSU Student Dental Clinic) Delta Dental Premier Network Out-of-Network
Annual Deductible $0 $50 per person $100 per person
Annual Maximum Benefit $1,500 per person1,3 $1,200 per person1,3 $1,200 per person1,3
Orthodontics has a separate lifetime maximum of $1,200
Preventive Services
(includes: cleanings, sealants, fluoride treatments, and space maintainers; bitewing, full-mouth or panoramic X-rays)
100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Emergency Palliative Treatments 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Endodontics
(root canals)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Oral Examinations 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Oral Surgery
(includes impacted tooth extraction)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Orthodontics 100% of allowed amount, up to $1,2001; no deductible 50% of allowed amount, up to $1,2001; no deductible 50% of allowed amount, up to $1,2001; no deductible
Coverage is only available for children up to age 19; $1,2001 lifetime maximum benefit. Benefits are pro-rated and paid over the course of the treatment.
Periodontics
(gum disease)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Prosthodontics
(includes dentures, fixed bridgework, and implants)
55% of allowed amount, no deductible; no balance billing2 50% of allowed amount; after deductible; no balance billing2 50% of allowed amount; after deductible; subject to balance billing
Restorative Services – Major
(includes cast restorations and crowns)
55% of allowed amount, no deductible; no balance billing2 50% of allowed amount; after deductible; no balance billing2 50% of allowed amount; after deductible; subject to balance billing
Restorative Services – Minor
(includes fillings, and repair of bridgework crowns, dentures, and onlays)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Temporomandibular Disorder (TMD) No coverage under the Dental Plan. Limited coverage is available under the Ohio State medical plans.
X-rays, All Others
(includes all diagnostic)
80% of allowed amount, no deductible; no balance billing 75% of allowed amount; after deductible; no balance billing 70% of allowed amount; after deductible; subject to balance billing

1 You are responsible for all costs over the maximums.
2 For any optional treatment (defined as a service that is more expensive than what is customarily provided or for which Delta Dental does not determine that a valid dental need is shown), you are responsible for the costs over the allowed amount, regardless of whether or not the service is provided in-network.
3 Some services are excluded from the annual maximum. A list of these services can be found in the Dental Plan Specific Plan Details (SPD).

NOTE: This Dental Plan Summary Chart should be used as a general guide only. Refer to the Dental Plan Specific Plan Details (SPD) for further information. If the information in the summary chart differs from the Specific Plan Details Document, the Specific Plan Details Document will govern.

If you use a network provider:

  • Tell the provider’s office that you are covered by Delta Dental when making an appointment, or at the time of service.
  • No claim forms are necessary for network dental services. Your dental provider should file claims directly with Delta Dental, although you may be required to pay for your portion of the expenses at the time of service.

If you use an out-of-network provider

  • The plan pays less for covered services than it does when you use a network provider.
  • Your provider may require you to pay for services in full and be reimbursed from Delta Dental by filing a claim.

To help protect themselves and their patients, dentists and staff are wearing more personal protection equipment (PPE) during appointments. This includes masks, face shields, gowns and gloves. The cost of these items has increased with demand, and as a result, some dentists are asking their patients to pay a separate charge for PPE.

However, Delta Dental participating dentists cannot charge you separately for PPE. Per their participation agreement, the cost of PPE is included in the cost of the dental service.

Protecting you from additional charges and fees is just one advantage of staying in network. If your dentist is out-of-network and they charge you for PPE, you are responsible for that cost.

What do I do if my dental office says I have to pay a PPE charge?
If they are in the Delta Dental network, remind them that they cannot charge you separately for PPE.

What if I already paid a PPE charge to my dentist?
If your dentist is in-network and billed you for the cost of PPE, you can submit a balance billing complaint to Delta Dental for follow up. Complaints should include the member name and phone number, date of treatment, dental office name and phone number, and the fee charge. Send complaints to Delta Dental, Attention: Balance Billing, PO Box 9230, Farmington Hills, MI 48333-9230.

What are you doing to help dental offices with the increased cost of PPE?
We understand the financial hardship the pandemic has placed on dentists and practices. That’s why we are offering any practicing, licensed dentist in Michigan, Ohio and Indiana a $1,000 credit to a dental supply distributor. This credit may be used to purchase PPE. Learn more about the provider relief credit by visiting deltadentaloh.com/dentistrelief.

Many Ohio State-based dental providers are included in Delta Dental’s networks.

  • The Ohio State University Student Dental Clinic is in the Delta Dental PPO network.
  • Some, but not all, of the providers within the Ohio State Dental Faculty Practice are in the Delta Dental PPO or Delta Premier network.

Upon your request, Delta Dental will determine benefit coverage prior to you receiving dental service(s) if the course of treatment is expected to be $200 or more. You or your dentist can send a written description of the procedures and the dentist’s proposed charges to Delta Dental before treatment begins.

The Delta Dental Mobile App helps you get the most out of your dental benefits anytime, anywhere. Use the dentist search or toothbrush timer without logging in, or enter your username and password to securely access your personal benefit information or estimate your dental care costs. Delta Dental’s free app is optimized for iOS (Apple) and Android devices. To download our app on your device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental. Delta Dental Mobile App information

Dental Plan FAQ

 

This is intended to be an overview. Refer to the Plan Document for complete information. In the event the information on these pages differs from the Plan Document, the Plan Document will govern.