Dental Plan Highlights

The city offers two dental coverage options: the Dental Health Maintenance Organization and the Dental Indemnity plans. National Pacific Dental Inc. provides DHMO coverage and Spectera Insurance Company provides indemnity coverage.

Your dental benefits in both plans will remain the same through April 2006. However, the contract for the DHMO plan requires a contribution increase of almost 8 percent, the first increase in three years. The dental indemnity plan rates will stay the same.

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. With the DHMO, you choose a primary care dentist who will coordinate your care and refer you to specialists as needed. You must live in the service area to enroll in the DHMO.

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, and
	A network that includes dentists and orthodontists.

 

DHMO Plan coverage	Copayment
Regular exam, cleaning (2 per year), x-rays	$0
Infection control, each visit	$3
Amalgam filling - 1 surface	$10
Retainer, each arch, post treatment stabilization	$95
Posterior composite fillings	$40
Immediate dentures	$300
Fixed appliance therapy	$560

National Pacific Dental DHMO dental plan brochures and election/change forms can be obtained from the human resources department. The brochures include a detailed list of procedures and copayments. Choose a primary dentist from the DHMO brochure, call National Pacific Dental customer service, (713) 861-8721, and register your dentist.

Counties in the DHMO:

Harris • Brazoria • Ft. Bend • Galveston Liberty • Montgomery • Waller

See the dental plan rates for employees

See the dental plan rates for retirees

Dental Indemnity Plan

A dental indemnity plan is a traditional dental 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 dental services and file a claim for reimbursement.

To use the plan:

	Make an appointment with the dentist of your choice.
	If the treatment will cost more than $200, get a cost estimate.
	Pay the dentist. Some dentists require patients to pay only their portion.
	File a claim for reimbursement within 90 days. Some dentists will file your claim for you.

The chart below shows some of the services provided under the dental indemnity plan. For a complete list of services provided under this plan, refer to the City of Houston Dental Indemnity Plan brochure.

Plan Features	Plan Pays
Preventive Services
Cleaning and oral examinations, bitewing X-rays	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	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	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	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 $750 per individual.
Annual Maximum Benefit	$1,000 per individual
Annual Deductible	$50 for each individual / $150 family
Referrals for Specialty Care	Not required
To Receive Reimbursement for Covered Services	Complete and submit a claim form.

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 a network of dental providers, you will receive a discount on your dental 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 $1,000 annual maximum benefit.

The city’s In-network Preferred Dentist Option brochure provides information about this feature as well as a list of preferred dentists in the network. Ask your department human resources liaison for a brochure.

	Important Note: To check the status of a claim, call (713) 861 - 8721. Mail your claim forms to: Spectera Dental, Inc. 1445 North Loop West Suite 500 Houston, Texas 77008 Important note: With the dental indemnity plan, you pay for services you receive at the time of your appointment and file a claim for reimbursement. If your dentist files the claim, you may be asked to pay only the portion the plan will not pay. You can get a claim form from your department human resources liaison. You must submit your claim within 90 days after the date of service. Reimbursement is made by mail, usually within 10 work days.

See the dental plan rates for employees

See the dental plan rates for retirees