Stars and Rumba
Common Procedures and conditions
Providers
Changes for 2025
Dental Plans
100

Contract H5521 - 459 has a Dental plan named ____.

Total PPO 20% Coins OON Hybrid

100

This Procedure involves removing a tooth

Extraction

100

This type of Dentist handles primary care concerns.

General Dentist.

100

These procedures will no longer be covered. and members will have to submit a claim prior to the start of the new year.

Implants and Orthodontics

100

The three types of benefit structures for indiv plans?

MSB, OSB, and Combo

200

this option is used at the top of the screen to select a providers network affiliation.

NV

200

This procedure involves removing the nerves and blood vessels

Root Canal

200

This type of Dentist cares for the Pulp and nerves of a patients teeth.

Endodontist

200

What type of plan will no longer be offered come 2025?

DMR

200

This type of benefit structure allows for coverage of all licensed providers, but requires members to submit a form after services. It also comes in either 100% or 50% coverage.

DMR

300

This program within Rumba is used to look up a providers fee schedule.

EPDB

300

Habitual clenching or grinding teeth, usually while sleeping.

Bruxism

300

This type of Dentist Specializes in the replacement of missing teeth or the repair of natural teeth.

Prosthodontist

300

This type of plan structure will no longer include implants and applies to retirees who are enrolled in a plan through the employer they retired with.

Scheduled Benefits

300

This type of plan does not allow for visits to OON providers.

EPO

400

This keyboard combination is used to unlock Rumba when "No Editing" is displayed in the bottom left corner.


CTRL+R

400

A removable Prosthesis

Dentures

400

If you you need surgery on your mouth, jaw, or face, what type of dentist would you see?

Oral or Maxillofacial Surgeon

400

These four ADA codes were removed from the Aetna Enhanced Standard/Premier PPO/ESA and Aetna Premier EPO plans

D7510, D7511, D7520, and D7521

400

This type of plan can charge their normal fee, the plans payment is based on the billed amount when seeing an OON provider.

Total Choice or Choice (2025)

500

Although we haven't done it during this training, this is a feature we can utilize in SCP when a member disagrees with a coverage decision we made and the standard TT would jeopardize the members' health.

Expedited Appeal

500

A highly trained surgeon usually performs this for conditions affecting the face, jaws, mouth, and neck. we did not know how say to Spanish (or the pronunciation in English)

Maxillofacial Surgeon

500

This Greek word means "around" and "tooth"

Periodontist

500

This particular additional benefit for employees who receive extra help will not offered in 2025 through Liberty Dental.

DVH Wallet

500

Scheduled Benefit Plans will add these two plan types in 2025.

Essential and Enhanced SNP