Depending on where you live, you may have a choice between UT DENTAL SELECT, the self-funded dental plan administered by Delta Dental, or Assurant Employee Benefits, a fully-insured dental HMO plan. Your Coverage Option Letter will tell you which plans are available to you.
The following chart shows which portion of the dental charges you are expected to pay and the service areas for each dental plan option:
1Reimbursement is based on a percentage of the allowable amount
2Excludes Oral exams, x-rays, cleanings, fluoride treatments, sealants, space maintainers
and specialist consultations
3Scaling, root planing and treatment of gum disease
UT DENTAL SELECT Highlights:
- You may see Network or Out-of-Network dentists
- DeltaPreferred Option dentists charge reduced contract fees
- No pre-approval needed to change dentists
- No referral needed to see a specialist
- 161,000 dental locations nationwide
- Delta Dental pays network dentists directly
Understanding Delta Dental's Unique Dentist Networks
DeltaPremier
UT DENTAL SELECT subscribers who choose a Delta Premier dentist receive these benefits:
- No advance billing
- No claim forms
- Dentist fees limited to DeltaPremier "allowance"
- No balance billing
- Out-of-pocket costs limited by Delta Dental's calculation of DeltaPremier "allowance"
- Credentialed dentist network
- Protection under Delta Dental's unique participating dentist agreements offering:
- quality assurance/consultant review
- cost management systems
- benefit of all Delta Dental policies and procedures
- Access to one of the largest dental PPO networks in U.S.
- 161,000 DeltaPremier Dental offices nationwide
DeltaPreferred Option (DPO)
UT DENTAL SELECT subscribers who choose a dentist from the smaller DPO network gain all the advantages of the larger DeltaPremier network plus:
- Out-of-pocket costs lower due to lower DPO "allowance"
- Discounted fee agreements average 30-35% off of submitted charges
- 86,000 DeltaPreferred Option (DPO) Dental Offices
Delta Dental Savings
Procedure: Two surface amalgam filling
| Sample Claim |
DPO Dentist |
DeltaPremier Dentist |
Non-Participating Dentist |
| Billed Charge |
$125 |
$125 |
$125 |
| Allowable |
$76 |
$101 |
$101 |
| Savings |
$49 |
$24 |
$24 |
| 80% Benefit Payment |
$61 |
$81 |
$81 |
| Patient Out of Pocket |
$15 |
$20 |
$44 |
Procedure: Porcelain Crown
| Sample Claim |
DPO Dentist |
DeltaPremier Dentist |
Non-Participating Dentist |
| Billed Charge |
$800 |
$800 |
$800 |
| Allowable |
$533 |
$710 |
$710 |
| Savings |
$267 |
$90 |
$0 |
| 50% Benefit Payment |
$267 |
$355 |
$355 |
| Patient Out of Pocket |
$266 |
$355 |
$445 |
*Billed charges are for illustration purposes only
Selecting and changing a dentist
At the time of enrollment you will need to select a Plan Dentist for yourself and each eligible member of your family. Each eligible family member may choose a different Plan Dentist.
There are two options to locating Plan Dentists:
The provider directory included in the enrollment booklet.
Search online at
www.assurantemployeebenefits.com/UT, under For Member. Select Find a dentist, then select Heritage Series.
Contact customer service at 800.443.2995 for assistance with changing your Plan Dentist.
The dental plan is simple to use when you follow these steps:
Verify with your Plan Dentist that you are on their roster before making a dental appointment.
Call early for routine dental care for the best availability of appointment times.
Be familiar with your copayment schedule to determine your costs for dental services.
Discuss concerns regarding proposed treatments with your Plan Dentist.
You may read additional information about plan features and exclusions in the Dental Plan certificates available in the UT DENTAL SELECT Plan Booklet or the Assurant Dental HMO Plan Booklet. Your Campus Benefits office has a limited supply available for those without internet access.
Contact Information
