Dental Plan - Human Resources at Ohio State

Dental Plan

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 you a choice of 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, 2018

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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 and 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 2018 Dental Plan Specific Plan Details (SPD).

NOTE: This Dental Plan Summary Chart should be used as a general guide only. Refer to the 2018 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.

Many Ohio State-based dental services 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.

Dental Plan FAQ

Delta Dental provides network coverage through Delta Dental PPO and Delta Dental Premier. The OSU Student Dental Clinic is in the Delta Dental PPO network. You can find network dentists online through the Delta Dental website.

The OSU Employee ID is to be utilized for this purpose since it is a number with which you should already be familiar. Delta Dental’s system requires a 9-digit identification number for eligibility and claims processing; therefore, if you have a:

  • 8-digit OSU Employee ID – your Delta Dental ID is your Employee ID with a leading zero added to it.
  • 9-digit OSU Employee ID – your Delta Dental ID is your Employee ID with no changes.

Dental cards are not required for services. If you would like to obtain a dental card for services, you can print one through the Consumer Toolkit.

Each enrolled member and their dependents may have two regular cleanings and exams in the plan year. Two additional cleanings will be covered when medically necessary. (Two additional cleanings per benefit year are considered medically necessary for individuals with at-risk conditions such as documented periodontal disease, diabetes, kidney failure, organ or bone marrow transplant recipient, and for individuals receiving dialysis, chemotherapy, radiation treatment, or are HIV positive.)

Coverage is dependent on the provider’s network affiliation and the dental service received. Please refer to the Dental Plan Summary Chart and the Dental Plan Summary Plan Description for details.

 

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.