UT Benefits for Retired Employees: Plan Year 2013-2014

Dental

UT Benefits and Delta Dental Insurance Company provide three plan options for retired employees and their families.

Dental PPO Plans

UT Benefits offers two dental PPO plans for you to choose from based on the level of benefits your family needs. Both dental PPO plans allow you the freedom to choose from any licensed dentist although you will save when you use a Delta Dental DPO or Delta Premier network provider.

  • UT SELECT Dental Plan (Standard Self-Funded Dental PPO Plan) – good for standard dental insurance needs
  • UT SELECT Dental Plus Plan (Enhanced FullyInsured Dental PPO Plan) – greater benefits than the standard UT SELECT Dental Plan
Dental Plan Comparison Chart
Dental Service UT SELECT Dental* UT SELECT Dental Plus*
Service Area** Use any licensed dentist, but save with the Delta Dental DPO or Delta Premier networks
Deductible $25 Plan pays deductible
Maximum Annual Benefit (per enrollee per plan year) $1,250 $3000
Orthodontic Maximum Benefits (Lifetime) $1,250 $3000
Diagnostic & Preventive Services (D&P) Exams, cleanings, x-rays, sealants 100% 100%
Basic Services Fillings, stainless steel crowns 80% 100%
Endodontics (root canals) Covered Under Basic Services 80% 100%
Periodontics (periodontal scaling, Root planning, and treatment of gum disease. Covered Under Basic Services 80% 100%
Oral Surgery Covered Under Basic Services 80% 100%
Major Services Crowns, inlays, onlays and cast restorations, bridges and dentures 50% 80%
Orthodontic Benefits Adults and dependent children 50% 80%

* Limitations may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist’s actual fees. Fees are based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists, and Premier contracted fees for non-Delta Dental dentists.
** Visit www.deltadentalins.com/universityoftexas to locate a network provider.

DeltaCare USA Dental HMO Plan

Available in Austin, Dallas/Ft. Worth, Galveston, Houston, and San Antonio. There is also limited availability in El Paso, Tyler, and part of the Rio Grande Valley. Plan eligibility is based on your zip code. Ask your benefits office if you are eligible to enroll in the DeltaCare Dental HMO. You must select and receive services from a DeltaCare plan dentist to use the benefits under this plan.

DeltaCare USA plans feature:

  • Set copayments.
  • No annual deductibles and no maximums for covered benefits.
  • Low out-of-pocket costs for many diagnostic and preventive services (such as professional cleanings and regular dental exams).

Choosing your DeltaCare USA dentist

When you enroll, you choose a DeltaCare USA Primary Family Dentist to receive benefits under your plan. You must visit your selected DeltaCare USA dentist to receive benefits under your plan. To find the most current listing of DeltaCare USA network dental offices:

  • Visit the Delta Dental website at www.deltadentalins.com/universityoftexas and go to the “Find a Dentist” box on the home page.
  • Select “DeltaCare USA” as your plan network, click “Search”, and follow the instructions.

You can also call Customer Service for help in finding a dentist. If you do not select a dentist, Delta Dental will select a dentist for you. Family members may select a different dentist for treatment within the covered service area. Refer to your plan booklet for details.

 

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