Getting The Most From Your Plan

When you enroll in the DHMO, you must select a Primary Care Dentist (PCD), who will take care of your dental care needs. If you need to see a specialist, your PCD will handle the referral for you. Unlike the DPO, the DHMO requires that your treatment be coordinated by your PCD for you to receive benefits.

Here's how it works:

It's important to keep in mind that the DHMO is available in California only and has a limited number of dentists in some areas. Before you choose this plan, you should be certain there's a DHMO dentist who is both convenient to you and accepting new patients. If you have a covered dependent who doesn't live with you, call PMI Customer Relations to determine whether a DHMO network is available where your dependent lives

To learn more about the dentists who participate in the DHMO network, you can:

• Call PMI Customer Relations for a list of participating dentists in your area; or
• Log on to the DHMO website to search for a provider online.

Network dentists occasionally change, so you'll want to make sure the dentist you choose is still in the DHMO network before you make an appointment. For the most up-to-date information, including whether a dentist is accepting new patients, call the dentist directly.

CHANGING PCDS
If you want to change your PCD, you may notify PMI by phone or in writing. You can also change your PCD online by visiting the DHMO website. If you make the change by the 21st of the month, the change will take effect on the first day of the following month. You can change your PCD as often as you wish.

If your PCD leaves the network, you'll be notified and asked to select another PCD. If you don't select a new PCD, one will automatically be assigned to you, based on your ZIP code. Having your PCD leave the network is not considered a qualified status change. That means that you won't be able to change your dental plan option until the next Open Enrollment period.

Using The DHMO Network
With the DHMO, when you go to your PCD or any other DHMO network dentist you've been referred to, you're responsible for any copay required at the time you receive services. The amount you're required to pay is detailed in the Summary Of Benefits or the Description of Benefits and Copayments you receive from the plan when you enroll.

There are no deductibles or copays for most diagnostic and preventive services or basic restoration services, no annual benefit maximum for general services - and no claim forms to file.

Non-Network Dentists
Except in an emergency situation, the DHMO doesn't pay any benefits if you go to a non-network dentist or if you receive care from a network dentist without the proper referral from your PCD. This is the case even if you have a covered dependent who doesn't live with you and there's no DHMO network where your dependent lives.

Emergency Care
The DHMO provides limited coverage if you or a cove red dependent needs emergency dental care while outside the DHMO's service area. You must be 35 or more miles away from your PCD to qualify.

The DHMO will reimburse you up to the applicable amount for services performed by a non-network dentist. After you receive emergency care, you must contact your PCD to discuss any follow-up treatment. See the footnote on page 12 of the Summary Of Benefits for the specific amount the DHMO will reimburse for emergency dental care each year.

To be reimbursed for emergency care, call PMI's Customer Relations for more information.