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Medicare Retirees Dental Plans

As a City of Fort Worth Retiree, you have four dental plan options available to you. Dental Preferred Provider Organization (DPPO) option with two plan choices and Dental Health Maintenance Organization (DHMO) option with two plan choices.

Rates

View 2017 Rates

</div> DHMO ---- The DHMO options (high and low) offer a more cost-conscious option with copays for most services. You must elect a primary care dentist with this plan and that dentist will act as the “gatekeeper” for your care and refer you to other types of dentists as needed. The DHMO plan will cover orthodontia for both adults and children up to plan limits. In the DHMO low plan, there is a copay per covered service rendered by your primary care dentist. Copays are listed in the fee schedule. When receiving services from a network specialty dentist, you are responsible for the specialist contracted rate rather than the copayment per service. The DHMO high option provides you with fixed copays for all levels of services provided you have received a referral to a network specialty dentist and the treatment plan has been authorized for payment. In the DHMO low plan, advanced services, such as bridges or crowns, are only covered if you go to your selected network general dentist. Services under a specialty network dentist will not be covered, however if you do need services from a specialty dentist, you will be able to pay the contract rate and not the full usual fee. DPPO ---- The DPPO options (high and low) offer you more freedom of choice for dentists. Both plans offer in and out of network coverage. A primary care dentist is not necessary and covered treatments are paid out on a coinsurance basis. You will NOT receive a card for the DPPO plans. The DPPO high option offers a higher annual maximum and higher levels of coinsurance. It also covers implants for all members and orthodontia is covered for children only up to age 19. The DDPO low plan has a reduced annual maximum and pays a lower coinsurance rate. Orthodontia and implants are not covered under the DPPO low option.

DeltaCare (DHMO) Dental PPO (DPPO)
Plan Feature DHMO - Low Option DHMO - High Option DPPO - Low Option DPPO - High Option
Deductible None None $50 per person $50 per person
Annual Maximum None None $1,000 per person $1,500 per person
Provider Member must use participating provider Member must use participating provider Unlimited - PPO Network available Unlimited - PPO Network available
Preventive & Diagnostic Care You pay fixed copayments according to the plan’s schedule of benefits You pay fixed copayments according to the plan’s schedule of benefits Plan pays 100% with no deductible Plan pays 100% with no deductible

Basic Restorative Care
You pay fixed copayments according to the plan’s schedule of benefits. Specialist referral is required under this plan. You pay fixed copayments according to the plan’s schedule of benefits - Specialist Referral is required under this plan. Plan pays 50% after
deductible
Plan pays 80% after
deductible

Major Restorative Care
You pay fixed copayments according to the plan’s schedule of benefits. You pay fixed copayments according to the plan’s schedule of benefits. Plan pays 50% after
deductible
Plan pays 50% after
deductible
Orthodontia Lifetime Maximum You pay fixed copayments according to the plan’s schedule of benefits. You pay fixed copayments according to the plan’s schedule of benefits. Not Covered Plan pays 50% after deductible
$1,000 Dependent children to age 26 and adults


Deductible
 
Annual Maximum
Not Covered Not Covered 50%

Subject to plan deductible

Annual maximum of $1,000 per person
50%

Subject to plan deductible

Annual maximum of $1,500 per person

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Contacts

Benefits office
Phone: 817-392-7782
Fax: 817-392-2624
Email

UnitedHealthcare
Phone: 844-634-1231

Delta Dental
DPPO: 1-800-521-2651
DHMO: 1-800-422-4234

Compass Professional Health Services
Email
Phone: 855-769-4377
Hours: 8 a.m.-6 p.m. Monday-Friday

City of Fort Worth CareToday Near Site Clinic
New Patient Line: 817-566-7453
Near Site Clinic: 817-566-7466
Address:
909 Ninth Ave., Suite 300
Fort Worth, TX 76104

Airrosti
Phone: 1-800-404-6050

Discovery Benefits (Health Savings Accounts)

Phone: 866-451-3399
Fax: 866-451-3245

Pharmacy: Envision
Helpdesk: 800-361-4542

Surgery Plus
Phone: 855-200-9508

UNUM
Phone: 1-800-858-6843

Voya/ReliaStar
Phone: 1-800-537-5024

Allstate
1-800-521-3535

Fort Worth Employees Retirement Fund
817-632-8900

457 Plans
TIAA-CREF
800-842-2252

Employee Assistance Program
Aetna Resources for Living
1-866-611-2826
www.mylifevalues.com

Healthy Challenge Wellness Program
Phone: 817-392-2623

VIVERAE
Phone: 888-VIVERAE (888-848-3723)

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