FA1 Attachment T-4: DHMO Provider Network Access Amendment 6 Instructions: Provide the following access information for each type of in-network provider listed in the access request (General/Family dentists, Endodontists, Oral Surgeons, Prosthodontists, Pedodontists, Periodontists, Orthodontists, and Other Specialist Dentists). Provide access two ways: 1) all employees and retirees currently enrolled in the DHMO and 2) all employees and retirees (entire census population). (Please note that the total number of employees/retirees excludes those employees/retirees located in Guam, Puerto Rico, Virgin Islands, countries other than the United States and APO addresses.) A. All employees and retirees currently enrolled in DHMO Average Employees Employees Not Total Number of Access Distance Matched Matched Provider Type Employees / Criteria to Retirees Number Percent Number Percent Providers General/ 28,640 28,613 2 in 8 Family Dentist Endodontists 2 in 10 28,640 28,613 Oral Surgeon 2 in 10 28,640 28,613 Prosthodontist 2 in 10 28,640 28,613 Pedodontist 2 in 10 28,640 28,613 Periodontist 2 in 10 28,640 28,613 Orthodontist 2 in 10 28,640 28,613 Other Specialist 2 in 10 28,640 28,613 Dentist B. All employees and retirees Average Employees Employees Not Total Number of Access Distance Matched Matched Provider Type Employees / Criteria to Retirees Number Percent Number Percent Providers General/ 119,000 119,272 2 in 8 Family Dentist Endodontists 2 in 10 119,000 119,272 Oral Surgeon 2 in 10 119,000 119,272 Prosthodontist 2 in 10 119,000 119,272 Pedodontist 2 in 10 119,000 119,272 Periodontist 2 in 10 119,000 119,272 Orthodontist 2 in 10 119,000 119,272 Other Specialist 2 in 10 119,000 119,272 Dentist
FA1 Attachment T-4: DHMO Provider Network Access Amendment 6 Instructions: Provide the following access information for each type of in-network provider listed in the access request (General/Family dentists, Endodontists, Oral Surgeons, Prosthodontists, Pedodontists, Periodontists, Orthodontists, and Other Specialist Dentists). Provide access two ways: 1) all employees and retirees currently enrolled in the DHMO and 2) all employees and retirees (entire census population). (Please note that the total number of employees/retirees excludes those employees/retirees located in Guam, Puerto Rico, Virgin Islands, countries other than the United States and APO addresses.) A. All employees and retirees currently enrolled in DHMO Provider Type Access Criteria Average Distance to Providers Total Number of Employees / Retirees Employees Matched Employees Not Matched Number Percent Number Percent General/ Family Dentist 2 in 8 28,640 28,613 Endodontists 2 in 10 28,640 28,613 Oral Surgeon 2 in 10 28,640 28,613 Prosthodontist 2 in 10 28,640 28,613 Pedodontist 2 in 10 28,640 28,613 Periodontist 2 in 10 28,640 28,613 Orthodontist 2 in 10 28,640 28,613 Other Specialist Dentist 2 in 10 28,640 28,613 B. All employees and retirees Provider Type Access Criteria Average Distance to Providers Total Number of Employees / Retirees Employees Matched Employees Not Matched Number Percent Number Percent General/ Family Dentist 2 in 8 119,000 119,272 Endodontists 2 in 10 119,000 119,272 Oral Surgeon 2 in 10 119,000 119,272 Prosthodontist 2 in 10 119,000 119,272 Pedodontist 2 in 10 119,000 119,272 Periodontist 2 in 10 119,000 119,272 Orthodontist 2 in 10 119,000 119,272 Other Specialist Dentist 2 in 10 119,000 119,272
DentalPlanAttachmentT-DHMOform.docx