School District Dental Benefits: Big Changes Ahead!
In 1963, when Bob Dylan penned the song The Times They Are a-Changin, he didn’t know he nailed the theme for healthcare benefits in the next century. But your dental insurance benefits are riding the steady wave of change. On January 1, 2020, the Washington State Education Association will be part of the School Employees Benefits Board (SEBB). This change represents a significant shift in coverage for many of our area’s teachers and support staff.
Through SEBB, district employees choose from three different dental plans. NONE of them equal the coverage you’ve had in past years. ONE of them allows you the same quality of care you currently enjoy, although at a higher cost. Carefully consider what these options mean in our area, which may be different than in other areas of the state.
Uniform Dental Plan (SEBB UDP – Group # 09600)
This plan is closest to what you have now. The most significant difference we see is that you will no longer have an incentive-based plan. That means you now have a co-pay for services other than preventive and diagnostic. For example, if you break a tooth and need a crown, your insurance will cover 50% of the cost, not 100% as in the past.
● Annual Maximum: $1750
● Deductible: $50 Individual, $150 Family (waived for preventative and diagnostic care)
● Preventative and Diagnostic: 100%
● Basic Coverage, including fillings, extractions, and root canals: 80%
● Crowns and Major Treatment: 50%
● Orthodontics: 50% up to $1750 lifetime maximum
KEY POINT: This appears to be the ONLY plan that you can utilize in our area and still choose your dentist and hygienist. The other two choices don’t have current providers here as of now.
2. DeltaCare (SEBB Group #09601).
This plan is a Managed Care plan that currently doesn’t include providers in our area. We encourage consumers to do more research on dental managed care and the limitations of this choice. Patients will be assigned a Primary Care Dentist within the Delta Dental of Washington DeltaCare provider network, likely in Wenatchee or Yakima.
The Willamette plan is another option for school employees utilizing a corporate dental system. This means you MUST use ONLY a Willamette-owned office for care. The closest location is in Spokane.
Frequently Asked Questions (Many questions are yet unanswered, but this is what we know so far.)
The benefit period is showing 11/1/18 – 12/31/2019 for Washington Education Association (WEA) group 00186, why is this? The Washington Education Association (00186) will be changing on January 1, 2020, to the School Employees Benefits Board (SEBB). This new plan will be a calendar year plan. So, on January 1, patients will have a new plan maximum and their benefit year frequencies will renew.
To accommodate for the extended benefit period, the Washington Education Association added additional funds and frequencies through the end of December. The benefit period maximum for group 00186 was increased to $2300 for patients who see a PPO provider, and $2000 if a patient sees a provider outside the PPO network. Additionally, there was a 3rdpreventative care visit added that includes a periodic exam, and a cleaning.
Can I have double coverage with my spouse’s plan? In the past, if you and your spouse each had coverage it often meant you would have coverage from both. For example, if you used all of your annual maximum and still had treatment needs, your spouse’s plan would cover the additional costs. Delta has been unable to confirm whether this benefit will be allowed under the new plans.
If I don’t choose a plan through open enrollment, I will default to one of the three options, right? YES. It’s CRITICAL that you choose the option you want, or you may default to a plan you can’t use where you want. But Delta is unable to tell us what that means to subscribers at this point.
We’ll Be Here For You
The direction of dental benefit plans remains cloaked in mystery. But dentistry will always be a high-trust, relationship-based profession where your connection with your provider matters most. Get the facts before making a decision, and feel free to reach out to our team with your questions.
With over 125 years of combined dental experience, our dental team offers care you can trust. We look forward to helping you maintain optimal dental health for years to come!