Delta Dental Transition
The ERS Board of Trustees awarded the third-party administrator contract for the Texas Employees Group Benefits Program (GBP) State of Texas Dental Choice Plan and Dental HMO plan to Delta Dental. Delta Dental will become the new third-party administrator (TPA) for the State of Texas Dental Choice preferred provider organization (PPO) plan, and DeltaCare, will become the new dental health maintenance organization (DHMO) carrier on September 1, 2019. These dental plans are available to Texas agency and higher education employees and retirees. The contract for both plans is for a six-year term beginning September 1, 2019 through August 31, 2025.
ERS is required to rebid the administration of its benefit programs on a regular basis to ensure they are providing competitive benefits at a reasonable cost. Delta Dental, offered more costs savings while still offering an equivalent or larger network of providers than other bidders. ERS chose Delta Dental for the PPO based on its large provider network and estimated costs that were lower than those of other companies that bid on the contract. ERS chose the DeltaCare USA DHMO with the understanding that the benefits and premiums will be very similar to the benefits in the current HumanaDental DHMO.
Delta Dental will begin administering the State of Texas Dental Choice plan and the Delta Dental HMO plan on September 1, 2019. HumanaDental will continue to manage the both plans through August 31, 2019. You will continue to be able to access your online claims with HumanaDental , by visiting http://www.humanadental.com/ers/.
Benefits remain the same
The State of Texas Dental Choice plan has annual deductibles and maximums. A deductible is the amount you must pay out of pocket for a type of procedure before your dental plan begins to cover services. A maximum is the total your plan will pay for dental services per person per year. You get two covered exams and cleanings per year. Orthodontic treatment is covered for adults and children.
The DeltaCare, USA DHMO does not have deductibles or maximums. You pay a copay (preset dollar amount) for most services. These copayments are listed in your plan booklet so you can budget in advance. If you need to see a specialist, choose an in-network dentist and pay 75% of the dentist’s normal fee. Your primary dentist will coordinate a referral to a specialist as needed. Orthodontic treatment is covered for adults and children.
Primary care dentist (PCD)
If you enroll in the State of Texas Dental Choice plan, you do not need to select a primary care dentist (PCD). You may visit any licensed dentist, anywhere. If you choose to visit a dentist that is not in the Delta Dental network you will have out-of-network benefits. To save money, visit an in-network dentist. This plan offers two networks: PPO and Premier. If you choose a dentist in the PPO network, you will pay less out of pocket and receive the highest level of plan benefits. If you choose a dentist in the Premier network, you will pay more out of pocket, but will still pay less than you would with an out-of-network provider. Visit www.ERSdentalplans.com to find an in-network dentist.
If you enroll in the DeltaCare USA DHMO, you must select a primary care dentist (PCD) from the plan’s network and use network providers to receive benefits. Visit www.ERSdentalplans.com to find a DeltaCare USA network dentist.
If you are currently enrolled in either dental plan, you will not need to reenroll this summer. Unless you make changes during Summer Enrollment, you and your covered dependents, who will be eligible to continue coverage on September 1, 2019, will continue enrollment in your current plan.
If you are not currently enrolled in a dental plan, you may choose to enroll in a plan during Summer Enrollment with coverage beginning on September 1, 2019.
August new hires who chose to enroll in dental coverage on their date of hire will have HumanaDental as their administrator through August 31 and will transition to Delta Dental on September 1
Delta Dental plan participants do not need ID cards. Participants may use the Delta Dental app or print an ID card from their online account beginning in September. Here are important things to keep in mind:
- Until September 1, 2019, participants should continue to use their current ID card.
- On September 1 and after, it is very important that participants remind their dental providers that their dental insurance is now through Delta Dental. This will help ensure that claims are processed correctly.
Medicare-eligible retiree coverage
Medicare-eligible retirees enrolled in HumanaDental DHMO, will be moved to DeltaCare USA DHMO on September 1, 2019. They will have to wait until Fall Enrollment or experience a qualifying life event (QLE) after August 31, 2019 to add or change dental plans, but can drop dental coverage at any time.
Medicare-eligible retirees enrolled in the State of Texas Dental Choice Plan will remain in the plan and Delta Dental will being processing their claims in September. They will have to wait until Fall Enrollment to make changes to their dental coverage, unless they experience a qualifying life event after August 31, 2019.
HumanaDental will continue to manage the both plans through August 31, 2019. You will continue to be able to access your online claims with HumanaDental , by visiting http://www.humanadental.com/ers/ .
Delta Dental will begin administering the State of Texas Dental Choice plan and the Dental Dental HMO plan on September 1, 2019. Participants in the State of Texas Dental Plan and DHMO may begin calling Delta Dental on June 24 regarding general benefits questions for Plan Year 2020 at toll-free (888) 818-7925 (TTY: 711), Monday – Friday from 8 a.m. to 7 p.m. CT. You may also view your State of Texas Dental Choice and DHMO benefits information for Plan Year 2020 that begins on September 1, 2019 at www.ERSdentalplans.com. More information will be added to this website in July and August.