The Open Dental Plan
What dental services are covered under the Open Dental Plan? The Fund’s Open Dental Plan is administered by Delta Dental of Massachusetts. The dental procedures covered under the Open Dental Plan and the Fund’s reimbursement schedule are listed in the Open Plan Reimbursement Schedule. Under the Open Dental Plan you may see any licensed general dentist or specialist you wish. How can I know in advance what my treatment will cost? Before starting any dental treatment which you consider costly, you are strongly encouraged to request that your dentist submit a pre-treatment estimate to Delta Dental of Massachusetts. Delta Dental will tell you, in writing, the maximum reimbursement you will receive. Your benefit is limited to your plan maximum. If you are enrolled in the Open Dental Plan and receive services from an MPE Preferred Provider, claims will be paid according to the Open Dental Plan reimbursement schedule. How do I receive services from a dentist? Under the Open Plan, you may visit any licensed general dentist or specialist you wish. The Fund will reimburse up to the amount listed in the Fund's Open Plan reimbursement schedule Because the Fund retains the services of Delta Dental of MA to provide third-party administrative services, Fund members are able to take advantage of some benefits offered to Delta Dental members. Your out-of-pocket costs may differ based on whether your dentist participates in Delta Dental in Massachusetts, Delta Dental outside of Massachusetts, or does not participate with Delta Dental. You should confirm with your dentist whether they participate with Delta Dental. If your dentist practices in Massachusetts and participates in Delta Dental: Your dentist agrees to accept a fee for service that is determined by Delta Dental. This fee is called a "maximum allowable fee". You are responsible for the difference between the Fund's reimbursement schedule and the dentist's maximum allowable fee. Your dentist will submit your claim directly to Delta Dental. You will receive an Explanation of Benefits (EOB) form after your claim is filed by your participating dentist. The patient payment column of your EOB shows the amount you owe your dentist. All Delta Dental payments to Massachusetts dentists are discounted by 5%, an amount which cannot be billed to you. If your dentist does not practice in Massachusetts, but participates in Delta Dental: Your dentist agrees to accept a fee for service that is determined by Delta Dental. This fee is called a "maximum allowable fee". You are responsible for the difference between the Fund's reimbursement schedule and the dentist's maximum allowable fee. Your dentist will submit your claim directly to Delta Dental. You will receive an Explanation of Benefits (EOB) form after your claim is filed by your participating dentist. The patient payment column of your EOB form shows the amount you owe your dentist.
If your dentist does not participate in Delta Dental: You must pay your dentist's actual charges directly. You must submit a claim form to Delta Dental, and Delta Dental will reimburse you directly.
How do I submit dental claim forms? You can obtain claim forms by calling Delta Dental at (800) 553-6277. Completed claim forms should be submitted to: When benefit payments are made directly to you it is your responsibility to pay your dentist. You are responsible for the difference between the Fund’s Open Plan reimbursement schedule for non-participating providers and the dentist’s full charge, less the 5% Delta Dental discounted payment if your provider is a Massachusetts dentist. In order to obtain the 5% discount you must present your MPE Plan ID card when you obtain services. Are there any limitations or restrictions on the Open Dental Plan? The Fund will pay up to $1,250* per person, per plan year, for covered dental procedures under the Open Dental Plan, exclusive of reimbursements for preventive and diagnostic services, and for orthodontic services. Delta Dental of Massachusetts reserves the right to reimburse you for an alternate course of treatment based on the materials and method of treatment which cost the least and which meet generally accepted dental standards. You will be reimbursed only the benefit allowed on the procedures specified under this alternate course of treatment. You have the right to appeal this determination in accordance with the procedure noted on the EOB form and in accordance with the Appeal Process. You must submit your Open Dental Plan claim forms to Delta Dental of Massachusetts within one year of the date on which you received dental treatment or you will not be reimbursed. The Fund will pay no more than $1,000 per person, per lifetime, for orthodontic treatment. (*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum.)
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