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Dental Highlights
A bright white smile is important for your bubblegum card. The city offers you two affordable options to help keep your mouth healthy. Your contributions remain the same as last year for the DHMO, but increase 9 percent in the indemnity plan.
| Dental contributions |
| |
Employee
bi-weekly cost |
| DHMO |
| Self only |
$4.50 |
| Self + 1 |
$9.70 |
| Self + 2 or more |
$13.73 |
| Dental Indemnity |
| |
From |
To |
| Self only |
$13.62 |
$14.85 |
| Self + 1 |
$31.50 |
$34.34 |
| Self + 2 or more |
$42.95 |
$46.82 |
DHMO
A dental health-maintenance organization is a network of dentists, like an HMO, that offers a comprehensive range of dental services for fixed copayments. You choose a primary-care dentist who coordinates your care and refers you to specialists. You must live in the service area to enroll. The DHMO is provided by National Pacific Dental.
Features of the DHMO include:
- No maximum annual limit on dental services
- No deductibles
- No claim forms to complete for most procedures
- A fixed copayment for dental services
- A network that includes dentists and orthodontists
Dental-indemnity plan
A dental-indemnity plan is a traditional plan that lets you receive a comprehensive range of dental services from the provider of your choice anywhere in the United States. You pay a percentage of charges for certain services and file a claim for reimbursement. The plan is provided by UnitedHealthcare Inc.
How you use the plan:
- Make an appointment with the dentist of your choice.
- If the treatment will cost more than $200, get an estimate.
- Get a claim form from the Human Resources benefits division.
- Pay the dentist. Some dentists only require patients to pay their portion.
- File a claim for reimbursement within 90 days of the date of service. Some dentists will file your claim for you.
- Mail the claim to:
- United Healthcare, Inc.
1445 North Loop West, Suite 500
Houston, Texas 77008
- Reimbursement is made by mail, usually within 10 days.
- To check on the status of a claim, call 866-605-2599.
For a complete list of services, refer to the City of Houston Dental Indemnity Plan brochure.
In-network preferred dentist option
If you are enrolled in the dental-indemnity plan, you can reduce your out-of-pocket costs by using a preferred dentist. If you receive care from a preferred dentist or network of dental providers, you will receive a discount on your services and have more money in your pocket.
As you can see in the chart below, if you use a preferred dentist, you will realize a considerable savings. The more costly the dental work, such as bridges or dentures, the more savings you will realize. Also, because all fees are reduced, you will receive more services before you reach the $1,500 annual maximum benefit.
Example savings using a
preferred dentist |
Plan |
Usual cost |
50%
coinsurance |
| Out-of-network |
$875 |
$437.50 |
| In-network |
$701 |
$350.50 |
| Your savings |
$87 |
Your dental plan benefits have not changed in either the DHMO or the indemnity plan. To help you decide which plan is right for you, the chart below gives you a comparison of sample copayments for some common dental procedures. Both plans offer free preventive services and are tailored to help keep your mouth healthy.
Comparison of DHMO and dental indemnity plan features |
| Plan feature |
DHMO
Sample copayments |
Dental Indemnity
Sample copayments |
Preventive services:
Cleaning and oral examinations, bitewing X-rays |
Preventive services - $0 |
The plan pays 100 percent of services up to usual and customary limits. $0 deductible. |
Basic services:
Extractions, root canals, oral surgery, restorative services (excluding gold fillings) and periodontal scaling |
Extraction, Coronal remnants - $9
Periodontal scaling - $14-$24
Root canal therapy, molar - $162 |
After you pay the annual deductible, the plan will pay 80 percent of services, up to usual and customary limits. |
Major services:
Initial fixed bridgework, crowns and dentures, replacement of bridgework |
Crown, titanium - $210
Complete denture, maxillary - $260
Immediate denture, maxillary - $270 |
After you pay the annual deductible, the plan will pay 50 percent of services, up to usual and customary limits. |
Orthodontic services:
Covered services up to two years |
Adult, 24-month case - $2,000
Adolescent, 24-month case - $1,800
Interceptive ortho service - $1,000
(primary and transition dentition) |
After you pay the annual deductible, the plan will pay 50 percent of services, up to usual and customary limits. The lifetime maximum benefit is $1,000 per individual. |
| Service area |
Counties include: Anderson, Bexar, Bowie, Brazoria, Brazos, Brown, Carson, Chambers, Collin, Dallas, Deaf Smith, Delta, Denton, Ellis, Fannin, Fort Bend, Galveston, Gray, Grayson, Grimes, Harris, Harrison, Hood, Hopkins, Hunt, Hutchinson, Jefferson, Johnson, Kaufman, Lamar, Liberty, Montgomery, Moore, Nacogdoches, Orange, Parker, Potter, Randall, Rockwall, Tarrant, Walker and Waller. |
Anywhere in the United States |
| Annual maximum benefit |
No annual maximum benefit |
$1,500 per individual |
| Annual deductible |
No annual deductible |
$50 for each individual/$150 family |
| Referrals for specialty care |
PCD must refer patient to specialist |
Not required |
| To receive reimbursement |
Filing a claim is not required |
Complete and submit a claim form |
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