Dental Care
What are my dental care options? The Fund offers its members a choice between three dental plans:
Members enrolled in the MPE Preferred Provider Dental Plan (also called the MPE Closed Plan) receive their dental treatment from the Plan’s 450 general practitioners and dental specialists listed in the Dental Providers. If you are enrolled in the MPE Preferred Provider (Closed) Plan, you must receive all of your dental treatment from a dental office which participates in the MPE Closed Plan: A list of current MPE Preferred Providers can be found in the Dental Providers section. To confirm your dentist's membership in the MPE Preferred Provider network, please call the MPE Unit at (800) 553-6277. (*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum.) If you enroll in the Dental Wellness Plan, you and your family must receive all of your dental treatment from the staff at the Oral Health Center located at Members who enroll in this plan will have their risk for dental disease assessed plus receive access to preventive techniques and healing therapies, when appropriate, that have been proven to reduce and eliminate the risks that lead to dental disease. These services may not be provided at other dental practices or covered by other dental plans. All necessary diagnostic, preventive and basic restorative services are not subject to an annual plan maximum and co-payments are the same as those under the MPE Preferred (Closed) Plan. All specialty services are subject to a $750 annual plan maximum even if the services are performed at the Oral Health Center (e.g., oral surgery, endodontic and periodontal treatment, etc.). This annual plan maximum does not apply to orthodontic services. (*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum) Members enrolled in the Open Dental Plan receive dental treatment from any dentist they select. If you are enrolled in the Open Plan and your dentist participates in Delta Dental of Massachusetts: You are responsible for the difference between the Fund’s Open Plan reimbursement schedule and the dentist’s maximum allowable charge with Delta Dental.Your dentist submits the claim forms and will receive the reimbursement check directly from Delta Dental Plan. Your plan has a $1,250* annual plan maximum for each family member each Plan Year, excluding preventive and diagnostic services and orthodontic services. If you are enrolled in the Open Plan and your dentist participates in the MPE Preferred Provider (Closed) Plan, you are subject to the above Open Plan guidelines. (*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum)
How do I choose a Dental Plan? Read the description of each dental plan and inform the Fund Office of your choice by completing an enrollment form. If you need an enrollment form call the Fund at (800) 325-5214. New members who fail to submit an enrollment form by their effective date will be automatically enrolled in the MPE Preferred Provider (Closed) Dental Plan with individual coverage only. Claims for your dependents cannot be paid until you submit a signed enrollment form and any required documentation to the Fund.
How do I change my Dental Plan? You may only be enrolled in one dental plan during the Plan Year which begins on July 1, 2008 and ends on June 30, 2009. You may change your dental plan only during the Fund's annual Open Enrollment period.
Must all family members enroll in the same plan? All family members must participate in the same plan. The only exception to this rule occurs when two or more family members are individually eligible for Fund benefits. In these cases each eligible member may enroll in a different plan.
Are there any exclusions or limitations on covered dental procedures? The Fund provides benefits only for necessary and appropriate services. The Fund provides benefits for a covered dental service that is determined by Delta Dental to be necessary and appropriate to diagnose or treat your dental condition. To be necessary and appropriate, a service must be consistent with the prevention of oral disease or with the diagnosis and treatment, on (1) those teeth that are decayed or fractured, or (2) those teeth where supporting periodontium is weakened by disease, in accordance with standards of good dental practice and not solely for your convenience or the convenience of your dentist. Delta Dental determines what is necessary and appropriate based on a review of your dental records describing your condition and treatment. It may be determined that a service is not necessary and appropriate even if your dentist has furnished, prescribed, ordered, recommended or approved that service. The Fund does not provide benefits for: If the Plan booklet does not expressly provide for a benefit or service, such benefit or service shall not be covered under the plan. By way of example, your expenses will not be covered and no benefits will be paid by the Fund for:
Important Note: Some services indicate that they are a covered benefit only once during the stated period of time (e.g. a crown is payable once every 60 months.) If you have previously received any of these services, no benefits will be payable if you receive the same service again within the stated period of time - even if you were not a member of the Fund, and regardless of what coverage, if any, on the original treatment date. For example, if you had a crown on July 1, 2004, you will not be eligible for another crown on the same tooth until a 60 month period has elapsed (July 1, 2009). Again, this applies even if you were not a member of the Fund, and regardless of what coverage you may have had, if any, on July 1, 2004. To avoid unexpected costs you should discuss any treatment with your dentist and submit a pre-treatment estimate. |
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