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The UT SELECT Dental Plus Plan - How Claims are Processed

The UT SELECT Dental Plus program includes the highest level of dental benefits offered by The University of Texas System. As an enrollee in UT SELECT Dental Plus, you have an annual maximum benefit of $3,000 ($1,250 from the UT SELECT Dental plan, and $1,750 from the UT SELECT Dental Plus plan). Here’s how dental claims are processed and why you receive two separate Explanations of Benefits (EOBs).

When a claim is received for a UT SELECT Dental Plus participant, it is first processed under the self-funded (UT dollars) UT SELECT Dental program. The maximum benefit under the UT SELECT Dental program is $1,250 annually for dental services ($1,250 orthodontic lifetime benefit) and claims are paid at 100% for Diagnostic and Preventive (D & P) services, 80% for Basic Services, and 50% for Major and Orthodontic Services. Regardless of the amount a provider bills for various services, benefits are paid based on the applicable percentage of the allowable amount for the service, which varies based on provider type (DPO Network, Premier Network, or non-contracting provider). With DPO and Premier providers, participants are never responsible for paying any amount over the allowable amount for covered services.

After the claim is processed under the UT SELECT Plan, it is automatically reprocessed a second time issuing payment under the fully-insured (Delta dollars) UT SELECT Dental Plus program. The UT SELECT Dental Plus program pays the UT SELECT Dental $25 deductible, an additional 20% for Basic Services, and an additional 30% for Major and Orthodontic Services until the UT SELECT Dental Plan maximum benefits are paid out. Below is an example of how a claim would process under this scenario when there is still benefit money available under the standard UT SELECT Dental Plan.

Sample Claim Payment - Major Service
Amount Billed by Dentist  $505.00
Amount Accepted by Dentist as payment in full
(Delta Dental's agreed upon fee)
 $381.00
UT SELECT Dental Plan pays first @ 50%  $190.50
UT SELECT Dental Plus Plan pays second @ 30%  $114.30
Patient Payment  $76.20

Once the $1250 UT SELECT Dental Plan dollars are exhausted, all additional claims are processed under the UT SELECT Dental Plus Plan at 100% for Diagnostic and Preventive Services as well as Basic Services, and 80% for Major and Orthodontic Services up to the additional $1750 dental/$1750 orthodontic maximums.

For additional details on the UT SELECT Dental plan, please review the Dental Plan Guide at: www.utsystem.edu/benefits/pubs/dental_uts_guide.pdf.

Dental Website Just for Kids - Introducing the Smyles

Meet the Smyles is a kid-friendly website to help kids learn about dental health through fun stories, games and tips. From the customized UT Dental homepage www.deltadentalins.com/universityoftexas scroll down under Just for Kids. When you click on Meet the Smyles you have several options of activity. What a great way for children to learn about dental the fun way.