Highmark-UCCI will assume the claim administration duties formerly provided by Prudential for dental coverage of University employees. Claims for dental services provided before Jan. 1, 1999, will be handled by Prudential. All claims incurred after that date will be administered by Highmark-UCCI.
Also, as recommended by the Task Force on the Future of Benefits, which recently released its report, Penn State is exploring the feasibility of establishing a preferred provider organization (PPO) for dental coverage as early as Jan. 1, 1999. Highmark-UCCI also would serve to administer a statewide network, if the decision is to establish a dental PPO.
Similar to the Healthpass PPO for medical coverage, under the provisions of the dental PPO, faculty and staff would be free to choose any dental care provider, but would realize lower out-of-pocket expenses when using network providers. While Highmark-UCCI would provide participants with additional information, the following are some frequently asked questions regarding a dental PPO program:
Q. Would the provisions of the Penn State dental plan, such as annual maximums, change with the Highmark-UCCI plan?
A. No. The provisions of the Penn State dental program would remain unchanged, including the $1,000 per person maximum annual benefit and the $1,250 maximum lifetime benefit for orthodontia.
Q. What is the advantage of using a preferred provider for dental coverage?
A. There are several advantages with a dental PPO, they include:
-- Annual deductibles are waived. The current Penn State dental plan has $25 per person/$50 per family annual deductibles.
-- Amounts that are "balance billed" would be reduced. Currently, there are three types of charges that are "balance billed" by providers to faculty and staff. These are 1) charges not covered by the plan, because they are in excess of "reasonable and customary" charges established by geographic area; 2) the faculty or staff member's share of reasonable and customary charges (20 percent for nonpreventive basic services or 40 percent for major services); and 3) amounts in excess of the maximums outlined above. A preferred provider in a dental PPO agrees to charge only at the reasonable and customary amount, so the first type of balance billed charges would not occur.
-- There are no payments required at time of service.
Q. If a PPO is established, how would the coverage be different if I chose to use a provider who was not part of the network?
A. The coverage level is reduced by 20 percent. Preventive services are reimbursed at 80 percent (instead of 100 percent), basic services at 60 percent (instead of 80 percent), and major services at 40 percent (instead of 60 percent).
Q. Is the Highmark-UCCI network currently sufficient to handle Penn State faculty, staff and dependents?
A. Across the Commonwealth, approximately 60 percent of all dentists are currently in the network. In the immediate State College area only a few dentists are in the network. That is why representatives will be meeting with local dentists to ask if they would like to be part of the network.
Q. What if a PPO is not fully established for January 1999?
A. The plan will continue as in the past. However, the PPO provisions would apply for anyone whose dentist already was in the Highmark-UCCI network, and he or she would pay no deductible and would not be balance billed for the amount in excess of the "reasonable and customary" charge. Highmark-UCCI representatives will continue to meet with dentists who are not in the network.
Q. What can I do if my dentist is not in the network?
A. The network is open to all dentists who meet normal credentialing criteria. Ask your dentist to consider joining, so that you can reduce your dental costs.
Q. What is in this for Penn State?
A. Penn State will save money in claims administration by changing to Highmark-UCCI.
Q. How will this affect my dentist if he/she joins the network?
A. Rather than your dentist charging you the full fee, your dentist will charge you only the "reasonable and customary" fee. Further, your dentist will be directly reimbursed by Highmark-UCCI for Penn State's share, with the remainder being paid by you as in the past.
Anyone with questions can contact the Employee Benefits Division by e-mail at Bene@psu.edu.