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ODS SeniorSelect Dental Plan Benefits Summary
It's easy to enroll and only available to ODS SeniorSelect subscribers. For more information, just us a request to have a complete SeniorSelect packet mailed to you. Or, call the ODS Individual Products Marketing Department at (503)243-3973 or 1-877-277-7073.
Return to SeniorSelect Summary
How To Use The Dental Plan
When you visit your dentist, tell him or her you are a member of an ODS dental program through the Delta Dental Plans of America. Your dentist will update your records with your new information and will submit claims for you.
- Calendar year maximum, per member: $1,500
- Calendar year deductible, per member: $50 (waived for diagnostic and preventive)
| Service | Coverage |
|---|---|
| Class I - Preventive | |
Examination/X-rays |
100% |
| Class II - Basic | |
Restorative (fillings) |
80% |
| Class III – Major | |
Crowns |
50% |
Additional Oral Health Benefits
Through our new Oral Health, Total Health program, ODS offers individuals diagnosed with diabetes the benefit of four cleanings a year instead of two. In addition to routine oral cancer exams, ODS provides coverage for ViziLite and Brush Biopsy, two non-surgical screenings designed to aid in the early detection of abnormal cells in the mouth.Advantages
- Freedom to choose your dentist
ODS is unique in that we have contracts with more than 2,000 licensed dentists in the Oregon. As the Delta Dental Plan of Oregon, ODS subscribers have the option to access more than 100,000 dental professionals nationwide. - Professional Arrangements
ODS has specific fee arrangements with our participating dentists in Oregon to ensure that actual charges made by the dentist do not exceed his or her accepted fees on file with ODS. - Pre-determination
As a service to our customers, your dental office may submit a pre-treatment plan to ODS on your behalf, and we will return it to them indicating the dollar allowance which will be covered by your plan.
New Member Eligibility
When selecting an ODS SeniorSelect Medicare supplement plan, you may also select the dental plan. New members are eligible to select the dental plan during a one-time only enrollment period. The dental plan effective date will coincide with your ODS SeniorSelect Medicare supplement plan effective date. Dental plan members may not retain the dental plan membership if eligibility in an ODS SeniorSelect Medicare supplement plan ends.
This is a benefit summary only. For a more detailed description of benefits, refer to your Member Handbook.
Limitations
If an eligible person selects a more expensive plan of treatment than is functionally adequate, ODS will pay the applicable percentage of the maximum plan allowance for the least costly treatment. The patient will then be responsible for the remainder of the dentist's fee.
- Diagnostic
Examination and bitewing x-rays covered twice per calendar year. Full mouth x-rays or a panoramic film limited to once every 3 years. - Preventive
Prophylaxis (cleaning) covered twice per calendar year. Fluoride application covered twice per calendar year. Sealant benefits are limited to the unrestored occlusal surfaces of permanent bicuspids and molars. Benefits will be limited to one sealant, per tooth, during any five (5) year period. Plaque control and oral hygiene or dietary instruction are not covered. - Restorative
(There is a 12-month waiting period)
If a tooth can be restored with a material such as amalgam, but another type of restoration is selected by the patient and dentist, covered expense will be limited to the cost of amalgam. Crowns and other cast restorations (including pontics) are covered once in a five (5) year period on any tooth. - Prosthodontic
(There is a 12-month waiting period)
A prosthetic device or crown will be covered only once in a five (5) year period provided the tooth has not been crowned within the past five (5) years.
Waiting Period
Class II and III services are subject to a 12-month waiting period. However, the waiting period will be waived if you provide evidence of 12 continuous months of prior dental coverage. The prior dental coverage must have been in effect on the date of enrollment in this plan or ended within 90 days of the enrollment date of coverage under this plan. Such prior coverage is called creditable coverage.
Exclusions
- Surgical placement or removal of implants and any other related services.
- Services covered under worker's compensation or employer's liability laws and services covered by any federal, state, county, municipality or other governmental agency except Medicaid.
- Services with respect to congenital or developmental malformations; including, but not limited to cleft palate, upper and lower jaw malformations, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint.
- Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion, or for stabilizing the teeth.
- Services begun prior to the date the individual became eligible for services under the program.
- Hypnosis, premedications, analgesics, anesthetics, local anesthetics or any other prescribed drugs.
- Hospital costs or any additional fees charged by the dentist because the patient is hospitalized.
- General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in the dentist's office or in conjunction with covered services when necessary due to concurrent medical conditions.
- Plaque control and oral hygiene or dietary instructions
- Experimental procedures or supplies.
- Charges for missed or broken appointments.
- Orthodontic services.
- Services for cosmetic reasons.
- Claims submitted more than 15 months after the date of rendition of the services.
- All other services or supplies, not specifically covered.
- Taxes
- Services or supplies for treatment of any disturbance of the temporomandibular joint