Dental Plan

Delta Dental of Ohio is the dental plan provider.

The Delta Dental plan gives you access to two large networks of participating dentists: Delta Dental PPO and Delta Dental Premier.

Your costs will be lower if your dentist is in the PPO network.

Eligibility

To sign up for dental coverage, you have to be eligible for, but you do not have to be enrolled in, SERS’ health care coverage.

You must enroll in dental coverage in order to enroll your spouse and/or children.


Open Enrollment Period

Dental plan enrollments are accepted from October 1 to November 15 every year. Coverage begins on January 1 of the following year.

Each year during open enrollment, you decide whether to keep, enroll in, or cancel dental coverage.


Premiums

Dental premiums are deducted from monthly payments. If your monthly payment is not enough to cover you monthly premium, SERS will bill you each month.


2018 Dental Premiums

PREMIUMS

Benefit recipient

$27.81

Benefit recipient and one dependent*

$55.62

Benefit recipient, and two or more dependents*

$83.70

*A dependent can be a spouse or a child


Maximum Coverage

$1,500 per person per calendar year


Provider Payment

Network dentists have agreed to accept Delta’s negotiated prices for various services. The percentages on the chart below show how much the plan pays. When a service is not covered at 100%, you pay the remaining portion.

Network dentists cannot charge you more than Delta’s negotiated prices. A non-participating dentist who charges more than the payment schedule can bill you the difference.


Dental Coverage Highlights

DELTA DENTAL COVERAGE
EFFECTIVE JANUARY 1, 2018

 

Plan Documentation Prevails

PPO DENTIST

PREMIER DENTIST

NON-PARTICIPATING DENTIST

DIAGNOSTIC AND PREVENTIVE

(no deductible)

Exams, cleanings, fluoride, emergency pain relief, sealants, brush biopsy, bitewing and full-mouth X-rays

100%

80%

80%

BASIC SERVICES ($50 deductible applies)

Minor restorative services, including fillings, periodontics, other X-rays, and other basic services

80%

60%

60%

MAJOR SERVICES ($50 deductible applies)

Repair to individual crowns, molar root canals, oral surgery services, crowns and veneers; relines and repairs to bridges, dentures, and implants; prosthodontic services for bridges, implants, and dentures

50%

40%

40%

* When you receive services from a nonparticipating dentist, the percentages listed indicate the portion Delta Dental will pay for those services. The nonparticipating dentist fee paid by Delta may be less than what your dentist charges, and you are responsible for the difference.


Locating a Network Dentist

To locate a network dentist near you:

  • Call your dentist’s office and ask if your dentist participates in the Delta Dental PPO or Premier network
  • Call Delta Dental’s customer service department toll-free at 800-524-0149
  • Visit Delta Dental’s online directory at www.deltadentaloh.com/sersohio, and click on the “Find a Dentist” icon

Vision Plan

Vision coverage is offered through VSP Vision Care, which serves more than 57 million people as the nation’s largest eye care plan provider.

The VSP plan also provides savings on hearing aids through the TruHearing MemberPlus program.

 

Eligibility

To sign up for vision coverage, you have to be eligible for, but you do not have to be enrolled in, SERS’ health care coverage.

You must enroll in vision coverage in order to enroll your spouse and/or children.


Premiums

Vision premiums are deducted from monthly payments. If your monthly payment is not enough to cover your monthly premium, SERS will bill you each month.


Open Enrollment Period

Vision plan enrollments are accepted every year from October 1 to November 15. Coverage begins on January 1 of the following year.

Each year during open enrollment, you decide whether to keep, enroll in, or cancel coverage.


2018 Vision Premiums

PREMIUMS

Benefit recipient

$ 7.11

Benefit recipient and one dependent*

$14.22

Benefit recipient and two or more dependents*

$16.70

* A dependent can be a spouse or a child


Provider Choices

  • VSP Preferred Providers
    • If you see a VSP preferred provider, your out-of-pocket costs will be lower.
    • To find a VSP provider, visit vsp.com or call VSP toll-free at 800-877-7195.
  • Non-Network Providers
    • You can choose any provider, national retailer, or local retail chain. However, if you see a non-network provider, your costs will be higher. If a non-network provider charges more than VSP allows, the provider can bill you the difference.

Vision Plan Highlights

Coverage with VSP Doctors and Affiliate Providers* Coverage Effective January 1, 2018

SERVICES

DESCRIPTION

CO-PAY

FREQUENCY

WellVision Exam

Focuses on your eyes and overall wellness

$10

Every calendar year

Prescription Glasses

$25

See frame and lenses

Frame

  • $180 allowance for a wide selection of frames
  • $200 allowance for featured frame brands
  • 20% savings on the amount over your allowance
  • $100 allowance for frames at Costco and Walmart Affiliate Providers*

Included in prescription glasses

Every other calendar year

Lenses

Single vision, lined bifocal, and lined trifocal lenses

Included in prescription glasses

Every calendar year

Lens Options

  • Polycarbonate lenses
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average 20-25% off other lens options
  • $0
  • $50
  • $50
  • $50

Every calendar year

Contacts (instead of glasses)

  • $150 allowance for contacts; co-pay does not apply
  • Contact lens exam (fitting and evaluation)

Up to $60

Every calendar year

* Coverage with a retail chain affiliate may be different. Once your coverage is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict of information, the terms of the VSP contract will prevail.