Frequently asked questions about the PEBB benefit changes 2008

How do I tell if a member is part of PEBB?

PEBB members can be identified by the group name listed on their ODS ID card or on Benefit Tracker.

Where do I get a complete list of all the benefit changes?

All the benefit changes for PEBB are listed on our website.

How do I get a copy of the criteria?

The criteria was mailed with our last letter and is available on the website.

For benefits which vary, how do I know in advance what services will be covered?

The benefits are based on your assessment, so if you determine the individual’s oral health or risk factor make more than one cleaning per year appropriate, then that is what is covered.

What is the difference between a calendar year benefit and a benefit that is every 5 years?

Calendar year means the benefit starts new January 1st of each year and the set number of services are allowed within the calendar year. A benefit that is every 5 years means that the benefit renews 5 years from the previous date of service. For example, if a service was performed on September 25, 2003, a 5 year benefit will not be available again until September 25, 2008.

Do I need to send in anything with the claim to get the extra benefit?

All you have to do is note in the patients chart of the dentist assessment of the patients oral health, by using PEBB’s outlined criteria.

What do I do if the patient just requests an extra cleaning?

We request you don’t bill insurance, and explain to your patient that the service will be a patient responsibility as your one cleaning has already been used. If you need to submit a claim, you can mark in the comments field “patient request”, or collect the money from the patient at the time of service and not bill ODS.

What specific implant services will be covered?

Implant placement is covered up to the plan limits. Details on other implant benefits will be in the member handbook.