*** Recipient of the ***
2003 New England Employee Benefits Council
'Best Benefits Practice'
Award
- What is the Dental Wellness Plan and why would I want to enroll?
- What dental services are covered under the Dental Wellness Plan?
- Are there any limitations in the Dental Wellness Plan?
- Covered services
- Co-Paid services
What is the Dental Wellness Plan and why would I want to enroll?
Great progress has been made in the last decade in understanding dental disease and its consequences. As we have learned more about the causes of tooth decay and gum disease, we have been better able to target preventive treatments to those patients with risk factors for the disease. These treatments may include mouth rinses that reduce the level of harmful bacteria that causes tooth decay or gum disease as well as the use of fluorides to put minerals back into the teeth before fillings are necessary.
The Oral Health Center is a state-of-the-art dental wellness center where the emphasis is on stopping or reversing the disease process through proven techniques and therapies. Members who enroll in this dental plan will have their risk assessed and may receive preventive care or healing therapies that may not be provided at other dental practices or covered under other dental benefit plans.
In order for preventive care to be effective, you must work with the Oral Health Center dentist and be willing to follow the treatment protocols that you and your dentist develop. This unique dental plan, based on your unique needs, will be designed to help you obtain and maintain optimal oral health. However, if you choose not to follow the advice of the treating dentist, you will not benefit from the added features of the Dental Wellness Plan. In that case, you should consider not participating in the Dental Wellness Plan and select a different dental plan during the Fund's Open Enrollment.
The Oral Health Center is located approximately 30 miles west of Boston and 20 miles east of Worcester. The Oral Health Center is located at:
2400 Computer Drive
Westborough, MA 01581
(508) 329-2250
What dental services are covered under the Dental Wellness Plan?
In addition to the benefits you are eligible to receive under the Closed Plan, the Dental Wellness Plan provides all necessary general dental care needed to restore and maintain your oral health. Co-payments for services are the same as those listed under the MPE Preferred Provider (Closed) Plan Co-Paid Services. In addition, you will receive the services listed below which are covered only under the Dental Wellness Plan. Your provider will formulate a sequential treatment plan. Your cooperation with and participation in this treatment plan is essential to improved oral health.
Your Oral Health Center dentist will work with you to decide if, and when, you need to see a specialist for services. 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.If the Oral Health Center is unable to provide specialty services, you will be referred to a specialist within the MPE Closed Plan.
(*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum.)
Are there any limitations in the Dental Wellness Plan?
You and your family must receive all your dental care from the Oral Health Center, unless your Oral Health Center dentist refers you to a specialist in the MPE Closed Plan. If you receive services at another dental office, or if you do not have a referral from your Oral Health Center dentist for specialty services you receive, no benefits are payable and you will be responsible for the dentist's submitted fees.
If your Oral Health Center dentist feels, for good reason, that he/she cannot continue to provide you with the care necessary for you to obtain and maintain optimal oral health, the Oral Health Center has a right to refuse to treat you as a patient, and you must request a change in your dental plan enrollment with the Fund office. Future benefits will be adjusted based on services that have been provided at the Oral Health Center.
Covered services
The Dental Wellness Plan offers the same coverage as the MPE Preferred Provider (CLOSED) Plan. Please refer to Paid-In-Full services and Closed Plan Co-Paid services for coverage information. In addition, the Dental Wellness Plan includes the following services as part of the treatment plan discussed with your Oral Health Center dentist:
| Procedure | Co-Payment |
| Risk analysis (all patients) |
$0
|
| Fluoride varnish for adults over 18 (moderate & high-risk patients) |
0
|
| Dental sealants-per tooth (ages 16-21 and moderate & high-risk patients) |
0
|
| Tooth remineralization procedure (all patients) |
0
|
| Chlorhexidine prescription to control dental disease infections |
0
|
| Prescription strength fluoride toothpaste (high risk patients) |
0
|
| Prescription strength fluoride mouthrinse (high risk patients) |
0
|
| Fluoride tablets |
0
|
| Xylitol remineralization tablets (once per plan year) |
0
|
Co-Paid services
These services are included in the Dental Wellness Plan as follows:
| Procedure | Co-Payment |
| Custom-made mouthguard |
$10.00
|
| Cosmetic teeth bleaching-external, per arch |
$99.00
|