Providers

Delta Dental

Delta Dental is pleased to provide you with the service you have come to expect from the industry leader in dental benefits.  In fact, providing the best service possible is so important to us that we made Quality Service one of our Core Values.  To that end, we've created many convenient ways for you to access any information you may need about your dental coverage.

Use your Computer

Visit consumer Toolkit® at www.deltadentaloh.com.  It provides all the information you need to learn about your plan, review claims and claim payments, access a searchable dentist directory, and more.

Use Your Telephone

Call DASI (Delta's Automated Service Inquiry system at 1-800-524-0149, 24 hours a day, seven days a week.  This system provides eligibility information, benefit levels, claim status, time limitations, available benefits for oral exams, cleanings and X-rays, our mailing address and the names of participating dentists near you.  If you have additional questions, you may exit the system to speak with a Customer Service associate at any time during normal business hours (Monday through Friday from 8:30 a.m. to 7:50 p.m. Eastern Time).

FrontPath Coalition

In order to keep cost under control and to provide quality medical care, the Health Plan is contracted with FrontPath coalition.

FrontPath (previously WLEC) was established in 1988 by eight Fortune 500 employers as a way to lower health care costs and increase competition among health care providers.  These employers realized by increasing competition in the health care market, Toledo could become a more attractive and affordable place to do business.  Today, FrontPath offers its members a highly competitive fee schedule which spans the full continuum of health care needs in regions where employees live and work. FrontPath continues to explore opportunities for growth in direct response to employer's needs.

FonthPath strives to improve the quality of health care for the entire community.  Through cooperative relationships with local hospitals, FrontPath collects discharge data, conducts analyses and shares important information with health care providers to foster improvements in the delivery of care for the entire community.

Our goal as a no-for-profit, is to offer employees access to affordable health care and quality initiatives.  We are pleased to offer value-added service to our members, and dedicated to serving them as well as the entire community.  FrontPath Coalition for plan information.

Spectera

Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone shoudl receive regular vision care.

With Spectera, you are able to visit any provider you choose, but you maximize your savings when you visit a network provider.

The Spectera vision program includes an Exam and Lenses every 12 months with Frames every 24 months or Contacts every 12 months in lieu of glasses. Be sure to read your full coverage details here.

Health Care Strategies - "Your Care Counselor Services"

What is the Care Counselor Service?
The Care Counselor Service is an additional feature of your Benefit Plan.  The Service is designed to provide you & your family with information & assistance regarding medical decisions and care.  Your Care Counselor is a medical professional who has received additional training to provide you with personalized information to identify & assist you in understanding options available to you through the medical community.  

When do I need to call the Care Counselor?
In order to maximize the benefits available through your Plan, you or your Physician must call  the toll-free Care Counselor number found on your Benefit Plan ID Card.

• CALL 800-582-1535
• Prior to any planned hospitalization
• Within 24 hours of an emergency admission to a hospital
• As soon as you know you are  pregnant

Check your Plan Booklet to determine if a call is required for Selected Therapies, Specialized Testing or Outpatient Surgery.

When you speak with your Care Counselor, you will be provided a CASE REFERENCE NUMBER".  You should make a note of your Case Number, Care Counselor's Name & Extension (you can dial it directly the next time you need to speak with them).

Will the Care Counselor tell me how much will be covered for tests, hospitalization or surgical procedures?
The Care Counselor can not answer questions concerning eligibility or benefits.  For information on coverage, refer to your Benefit Plan booklet of contact your Claims Payer.

How do I reach my Care Counselor?
Simply dial the toll free number: 800-582-1535

The Care counselor Service is available 24 hours a day, seven days a week.

What information will I need to provide?
When you call...your Care counselor will ask for: 

• Your Name
• Employer
• Phone Number
• Employee's Social Security Number
• Name & Phone Number of your Doctor & Hospital

If your Care counselor is assisting another participant, you may choose to leave a message indicating the convenient time for a return call.  Your call will be returned as soon as possible.  

All information provided to your Care Counselor is treated confidentially.

Medical Information HELPline
What if YOU had questions about...

• where you could obtain medical treatment or service?
• what new medical technologies are developing?
• details on a particular diagnosis or procedure?
• safe use of prescriptions or over the counter medications?

To help you answer questions like these and maneuver more comfortably through the often confusing medical care system, our benefit plan provides a special service. 

Your Medical information Helpline
The Medical Information HELPline provides toll-free access to valuable heath care information.  Calls answered by our staff of professional Registered Nurses, responding to your questions and offering information over the phone.  In addition, printed and electronic materials are available on a variety of health related topics.  

The service can be reached 24 hours a day, 7-days a week.  Calls placed during the regular business day receive immediate information.  

Inquires requiring further investigation, late-night or weekend calls sometimes require additional research.    

So the next time you face a question about medical care, side-effect, treatment choices or simply need information about how to locate a qualified health care provider, call... Medical Information Helpline at: 1-800-582-1535 press "9" to transfer directly to the HELPline nurses.

Case Managers

• Advocate on behalf of individuals & families
• Provide confidential education & specific teaching to facilitate recovery & improve quality of life.
• Focus on teaching patients how to navigate the healthcare system & access quality medical care.
• Support patients & treating physicians to improve health outcomes, while limiting out-of-pocket costs to patients
• Assist individuals in accessing "Centers of Medical Excellence" for treatment of illness or injury when appropriate
• Collaborate, facilitate & coordinate health care services based upon the personalized needs of the patient & family.

RESTAT

Prescription Drug Plan co-payments:

• Generic Drugs are the 1st tier (lowest co-pay): $5.00
• Preferred Brand Drugs are in the 2nd tier (middle co-pay): $15.00
• Non-preferred brand drugs are in the 3rd tier (highest co-pay): $30.00

In most cases, brand drugs with a generic equivalent fall into the 3rd tier while the generic equivalent will be available in the 1st tier.

  

WORKPLACE RESOURCES 
by Sue Cervantes, EAP        

I would like to take this time to remind all members and their families of the benefits provided by the Employee Assistance Program.  Our provider, Workplace Resources is a short-term problem resolution, assessment and referral program available to you and your family members.  This service is provided to you at NO charge.    

Some situations may require a referral recommendation.  Should you decide to accept the referral, your Health Plan benefits may then be accessed.  By going through Work Place Resources first, your Health Plan coverage is increased.  As always, your involvement is Confidential.  No one knows you are using EAP unless YOU choose to tell them.  EAP can work with a verity of issues including alcohol and drug abuse, martial problems, dysfunctional family relationships, anxiety, work-related issues, financial hardship and legal programs.