The Fund offers its members a choice between two dental health plans:
If you are enrolled in the MPE Exclusive Provider Network (EPN) Plan, you must receive all of your dental treatment from a dental office which participates in the MPE Exclusive Provider Network (EPN) Plan.
Your dentist submits the claim form(s). Some procedures require a patient co-payment that is payable directly to the dentist. Your plan has a $2,500* annual plan maximum for each family member each Plan Year. There is a separate Implant Annual Plan Maximum of $1,500*. Payments for orthodontics, preventive, diagnostic, periodontal scaling and root planing treatment and immediate and complete dentures are not deducted from this annual maximum. If you are enrolled in the EPN Plan and receive services from a dentist that does not participate in the MPE EPN Plan, no benefits will be paid by the Fund.
Members who enroll in the Indemnity Plan have a $2,500* annual plan maximum for each family member each Plan Year. there is a separate Implant Annual Plan Maximum of $1,500*. Payments for orthodontics, preventive, diagnostic, periodontal scaling and root planing treatment and immediate and complete dentures are not deducted from this annual maximum.
If you are enrolled in the Indemnity Plan and your dentist participates in Delta Dental:
You are responsible for the difference between the Fund’s reimbursement schedule and the dentist’s fee with Delta Dental. Your dentist submits the claim forms and will receive reimbursement directly from Delta Dental of MA.
If you are enrolled in the Indemnity Plan and your dentist does not participate in Delta Dental:
You are responsible for the difference between the Fund’s reimbursement schedule and your dentist’s actual charge. Your dentist may require you to submit claim forms and the reimbursement from Delta Dental of MA will be sent directly to you.
If you are enrolled in the Indemnity Plan and your dentist participates in the MPE Exclusive Provider Plan, you are subject to the above Indemnity Plan guidelines.
*Commonwealth of MA Seasonal Employees annual plan maximum is equal to 50% of stated maximum.