Beginning in 2013, Duke employees can choose from three dental options. All three options cover preventive, basic and major services, but they differ in how they pay for covered services. Under each plan, you can visit any licensed dentist. Duke's dental plans are available to retirees who have continued their dental insurance in retirement.
Preferred Provider Option (PPO) Plan
This newest option offers similar coverage to Plan A at a lower monthly premium for employees who use dentists within a nationwide network.
The PPO plan includes no deductibles, a higher maximum annual benefit than Plan A and Plan B, and lower negotiated procedure rates. These provisions can lower participants' out-of-pocket expenses when using in-network dentists.
Prior to signing up for the PPO plan, you should review the network to make sure you are comfortable with the number of providers in your area. If you do not plan to use an in-network provider, do not sign up for the PPO plan.
A list of in-network dentists is available here.
Plan A and Plan B
With Plan A and Plan B, you may visit any licensed dentist. Both plans include deductibles that must be met before coverage begins for non-preventive procedures.
Plan A and Plan B reimburse participants based on the usual and customary (U&C) allowable charge for each covered service. Plan A has higher monthly premiums than Plan B, but reimburses participants more of the cost of the service. If a dentist charges more than the U&C charge, the participant is responsible for the excess charge.
Fee schedules for Plan A and Plan B are available on the Ameritas website.
If you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2013, you or the dependent will be considered a "late entrant." As a "late entrant" your benefits during the first twelve months of coverage will be limited to preventive services: two preventive care exams (not including X-rays), two cleanings, and for children under age 19, one fluoride application. Once you have been enrolled in the Duke dental insurance for at least one year, the insurance will also cover basic and major procedures such as fillings, extractions, crowns and root canals.
If you are switching from one Duke dental plan to another Duke dental plan, this twelve-month waiting period does not apply. The waiting period also does not apply if you enroll a child within 30 days of their second birthday, or to participants who enroll within 30 days of a qualifying event such as marriage, adoption, or loss of employee group dental insurance.
Annual Maximum Benefit
All three plans have an annual maximum benefit. If you reach this annual maximum benefit, the insurance company will not reimburse any additional services for the remainder of the calendar year.
Dental plan members who had at least one dental claim filed in calendar year 2012, with less than $500 in claims payments, will have their annual maximum benefit increased by $250 in 2013. This accumulation can continue each year until the annual maximum has increased on the PPO plan from $1,250 to $2,250; on Plan A from $1,000 to $2,000; and on Plan B from $750 to $1,750.