1. Veterans Affairs Dental Insurance Program
Hello and thank you for coming. My name is ( ) and I am the ( ) representative for the Veterans Affairs Dental Program. I’ve been with Delta Dental for _ years, working with ________. I ‘m very excited to tell you about our new VADIP program so let’s get right into it.
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2. Agenda Introduction Eligibility Enrollment Program Features Premiums
Network Dentists
Non-Network Dentists
Resources
Questions?
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3. Introduction VADIP went into effect on January 1, 2014
Service area includes the U.S., the district of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands
Three reasons why Delta Dental’s VADIP is the plan for you:
Dedicated to dental benefits for 50+ years
No deductible options available
Expansive dentist network nationwide
For the first time in history, the U.S. government has authorized a national dental insurance program for eligible VA beneficiaries. Enrollment started November 15th and is ongoing- there is no “open enrollment period.” Coverage begins January 1st, The VADIP service area includes….
Delta Dental is pleased to be able to offer this new dental program. Delta Dental has successfully administered federal government dental programs for over 25 years and we have been in the dental benefits business for over 50 years. Dental is all that we do. As you will see in the slide presentation, we offer a no deductible option and we offer an expansive network of dentists nationwide.
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4. Eligibility Eligible VADIP beneficiaries include Resources
Veterans enrolled in VA healthcare
Individuals enrolled in VA’s Civilian Health and Medical Program (CHAMPVA)
Resources
VADIP:
Veterans Affairs: or VETS (8387)
CHAMPVA: or
To be eligible for the VADIP you must be a Veteran that is enrolled with the VA healthcare or an individual enrolled in VA’s Civilian Health and Medical Program (CHAMPVA). Dependents who do not qualify as a CHAMPVA beneficiary are not eligible.
For more information on VADIP, go to deltadentalvadip.org
To enroll in VA health care or for VADIP eligibility questions, visit the Veterans Affairs website at or call VETS (8387).
To enroll as a CHAMPVA beneficiary, visit the CHAMPVA website at or call
FYI: these URLs and #s are in the brochure.
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5. Enrollment VADIP website: deltadentalvadip.org Mail application to:
Delta Dental of California
Federal Government Programs
P.O. Box Sacramento, CA
Veteran chooses a plan, submits application, premium prepayment and electronic funds transfer (EFT) information.
You can enroll online by going to our website at deltadentalvadip.org OR you can mail your application (the address is on the enrollment app) to Sacramento, CA, at P.O. Box A brochure is available to help you choose your plan. A premium prepayment and Electronic Funds Transfer (EFT) info from your savings or checking account is required for enrollment.
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6. Enrollment VADIP enrollment process (continued): Enrollment commitment
Initial 12-month commitment
Continuing month-to-month
Delta Dental processes application
Coverage begins the first day of the month following acceptance of the enrollment application
No enrollment card required
There is a 12-month enrollment commitment under the VADIP. Once that is met, the Veteran has the option to remain enrolled on a month-to-month basis as long as the Veteran remains eligible for coverage and VA continues to authorize VADIP. Enrollees have a 30-day grace period from their coverage effective date to decide if they want to remain enrolled in the program. Provided that they have not used any of the benefits, new subscribers are welcome to disenroll at any time during the 30-day grace period.
It is extremely important to note that the Veteran can start using the program on the 1st day of the month following enrollment. For example, if they enroll at any point in January, their coverage effective date is February 1.
Once enrollment is processed and confirmed, we will send you a welcome with information explaining where to find information on the plan you chose (Standard, Advanced or Comprehensive). If you do not provide an address, a welcome packet will be mailed to you.
When visiting a Delta Dental PPO dentist, simply provide your SSN or ID number. An ID card is not required, however, if you choose, you do have the option to print an ID card by going to deltadentalvadip.org.
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7. Program Features Three plans to choose from
Expansive dentist network nationwide
Benefit year – January 1 to December 31
Annual maximums
Standard: $500
Enhanced: $1,000
Comprehensive: $1500
Deductible:
$50 (Standard and Enhanced)
No deductible (Comprehensive)
Coordination of Benefits
The VADIP offers three plans to choose from (Standard, Enhanced, Comprehensive), which we will discuss more on the next slide. We also offer an expansive network of dentists. Currently, there are more than 184,000 provider locations nationwide. The benefit year for the VADIP is January 1 – December 31.
The standard plan has an annual maximum of $500 per person, the enhanced program has an annual maximum of $1,000 per person and the comprehensive program has an annual maximum of $1,500 per person.
There is a $50 deductible per person, per benefit year for certain services under the Standard and Enhanced plan. However, the deductible is waived for diagnostic and preventive services under the Enhanced and Comprehensive plans. There is no deductible under the Comprehensive plan for any services.
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8. Standard Plan Diagnostic and Preventive – 100% / 80%
Basic Restorative – 50% / 30%
Oral Surgery
50% / 30%
Simple extractions only
Deductible – $50
Annual Maximum – $500
Under the Standard plan, cleanings, exams and annual x-rays are covered 100% if you go to an in-network dentist. If you go to an out-of-network dentist you are covered 80%. You’re covered 50% for basic restorative services with an in-network dentist and 30% for basic restorative services with an out-of-network dentist. Oral Surgery is covered 50% in-network and 30% out-of-network, however, there is a 12 month waiting period for oral surgery and simple extractions are the only covered service for oral surgery. There is a $50 deductible applied per person, per benefit year with an annual maximum of $500.
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9. Enhanced Plan Diagnostic and Preventive – 100% / 80%
Basic Restorative, Endodontics and Periodontics – 50% / 30%
Oral Surgery
50% / 30%
Simple extractions only
Deductible – $50*
Annual Maximum – $1000
Under the Enhanced plan, diagnostic and preventive services are covered 100% in-network and 80% out-of-network. Basic restorative (fillings), endodontics (root canals), and Periodontics (gum treatment) are covered 50% in-network and 30% out-of-network. There is a 12 month wait for oral surgery before it’s covered 50% in-network and 30% out-of-network. Simple extractions are the only covered services for oral surgery. There is a $50 deductible applied to all services other than diagnostic and preventive which is waived for those services. There is a $1,000 annual maximum.
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10. Comprehensive Plan Diagnostic and Preventive – 100% / 80%
Basic Restorative – 60% / 40%
Endodontics, Periodontics and General Services – 50% / 30%
Oral Surgery – 50% / 30%
Major Restorative and Prosthodontics – 50% / 30%
12 month wait
Deductible – $0
Annual Maximum – $1500
Under the Comprehensive plan, diagnostic and preventive services are covered 100% in-network and 80% out-of-network. Basic restorative services are covered 60% in-network and 40% out-of-network. Endodontics, periodontics, and general services are covered 50% in-network and 30% out-of-network. There is a 12 month waiting period for Major Restorative, Oral Surgery and Prosthodontics to be covered at 50% in-network and 30% out-of-network. There is no deductible applied at all under comprehensive and the annual maximum is $1500. Orthodontics are not a benefit under any of the plans.
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11. Premiums Premiums vary by region
5 premium regions based on zip code
Monthly premiums for 1/1/14 to 12/31/14
Standard, Enhanced or Comprehensive
Standard
$ $12.90
Enhanced
$ $19.65
Comprehensive
$ $35.21
VADIP premium rates are based on the zip code and the number of CHAMPVA members you enroll. We offer three plans and the monthly premiums are based on the plan that you choose and your location. The ranges are as follows: Standard plan premium range $ $12.90 pp per month, Enhanced plan premium range $ $19.65 pp per month, Comprehensive plan premium range $ $35.21 pp per month. To find out your specific premium rate, visit the website at deltadentalvadip.org.
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12. VADIP Network Dentists
More cost savings, best value
Accept the “allowed fee” as the maximum billing fee for covered services
Charge only the applicable estimated copayment at the time of service
Submit your claim to Delta Dental at no charge
Two cleanings, two exams and one x-ray in a 12-month period with no copayment (Enhanced and Comprehensive plans only)
Dentist Search button on home page of deltadentalvadip.org
To save enrollees the most out-of-pocket money, Delta Dental offers a dentist network with over 150,000 participating dentist locations nationwide. These dentists belong to the Delta Dental PPO network. These network dentists have agreed to pre-negotiated fees and to submit all claims paperwork for you. For basic services like annual cleanings, exams and an x-ray, seeing a network provider ensures that you won’t have any copayment at all. Seeking care from a network dentist ensures lower costs and provides you a cost-containment feature. Contrary to that, if you go to a non-network provider, there is no ceiling as to what they can charge you.
In addition to accepting the allowed fee and submitting your claim form for you at no cost, as well as adhering to strict quality of care standards, network providers have also agreed to only ask you for your co-payment level upfront. If you see a non-network provider, however, he/she can ask you for all of the money upfront and then you will wait for the check from the program. To find a network dentist, go to deltadentalvadip.org and click on “Dentist Search” on the Home page.
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13. Non-VADIP Network Dentists
Bill you for their normal fees and you pay the difference
Most likely is higher than allowed amount
May not submit paperwork for you
Responsible for full payment up front
If you choose to seek treatment from a non-network dentist, the VADIP will pay the same percentage for covered services but cannot guarantee the dentist’s fees. Out-of-network dentists will bill you for their normal fees, which most likely will be more than the program allowed amount. You will be responsible for the difference between the dentist’s fee and the VADIP allowed amount, plus your deductible, if applicable.
When verifying a network dentist’s status, it is important that enrollees specifically ask whether their dentist is participating in the Delta Dental PPO network for the Veterans Affairs Dental Insurance Program. Participating is different than accepting.
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14. deltadentalvadip.org Lynn Jamroz ljamroz@delta.org 630-587-6397
VADIP Resources
deltadentalvadip.org Lynn Jamroz
It is our goal to serve you as well as you have served our country. If you ever have any questions about the program, enrollment, providers, etc, please visit our website. On our website you’ll also find the latest news and updates on the VADIP, complete program information, a list of participating dentists, specific premium rates, online enrollment and inquiry forms and a whole lot more. We’re always a click away.
Thank You!
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15. Questions?
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