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  Dental Plan Summary

The Maine School Management Association Dental Trust Fund offers four dental plans through the Group Dental Trust Fund. Maine School Management Association acts as plan administrator for the dental insurance trust. The team in the Group Insurance Department is ready to help members understand their benefits and offer education to staff who administer the programs in their schools.

Patient Advocates, LLC pays claims for our dental program. This is a Maine company based in Gray with whom we have worked since 1999. Their customer service team is also available to our members and dental providers for answers to claim questions. They can be reached at 1-800-290-8559.


General Plan Highlights

  • No network - Subscribers and covered dependents may visit any dental provider in or out of Maine

  • Claims are processed in state with an average turn-around time of 4 days after receipt of claim

  • No waiting period for benefits

  • Each covered member may utilize up to $1300 in benefits per calendar year (January - December)

  • Preventive services are covered in full subject to usual, customary and reasonable charges

  • MSMA administers the COBRA program for all eligible employees and/or dependents

  • Benefits are extended to retired employees

Dental Plans

Plan 1 $50 Individual Deductible ($150 Maximum per family)
Plan 2 $25 Individual Deductible ($75 Maximum per family)
Plan 3 $50 Individual Deductible ($150 Maximum per family) Orthodontia not covered
Plan 4 $25 Individual Deductible ($75 Maximum per family) Orthodontia not covered
Plans 1 and 2 cover procedures listed below under Classes 1, 2, 3 and 4.
Plans 3 and 4 cover procedures listed below under Classes 1, 2 and 3.


Contact MSMA customer service with questions.

All plans have a maximum of $1300 in benefits paid per family member for Class 1, 2 and 3 services.
 


Class 1 Procedures - Diagnostic and Preventive (Partial Listing)

*Clinical oral examinations - - 2 in any one calendar year
*Intra-oral x-rays -- complete series (including bitewings)-- limit 1 series in a 36 consecutive month period
*Bitewing -- limit to 2 in any one calendar year
*Dental prophylaxis -- limit to 2 in any one calendar year
*Fluoride treatments -- for individuals under 19 years of age -- limit to one treatment in any 12 consecutive month period

Coverage
Plan 1: Payment 100%
Plan 2: Payment 100%
Plan 3: Payment 100%
Plan 4: Payment 100%


Class 2 Procedures - Basic (Partial Listing)

*Fillings -- Amalgam, silicate, acrylic or plastic
*Root canal therapy
*Periodontal scaling and root planing
*If more than one periodontal surgical procedure is performed per quadrant, only the most inclusive is considered a dental procedure
*Adjustment of dentures
*Replace broken tooth on complete or partial denture
*Extraction of Wisdom Teeth
*Emergency Treatment
*Anesthesia

Coverage
Plan 1:  Plan pays 80% after a $50 deductible is met
Plan 2:  Plan pays 80% after a $25 deductible is met
Plan 3:  Plan pays 80% after a $50 deductible is met
Plan 4:  Plan pays 80% after a $25 deductible is met


Class 3 Procedures - Major (Partial Listing)

*Crowns, bridges, dentures, implants (upon review)
*Complete and partial dentures (includes 6 months of post-installation care)

Coverage
Plan 1:  Plan pays 50% after a $50 deductible is met
Plan 2:  Plan pays 50% after a $25 deductible is met
Plan 3:  Plan pays 50% after a $50 deductible is met
Plan 4:  Plan pays 50% after a $25 deductible is met


Class 4 Procedures - Orthodontic Coverage (Partial Listing)

*Orthodontic benefits are limited to dependent children under the age of 19. The maximum lifetime benefit is $1100.
*Comprehensive orthodontic treatment preliminary study including cephalometric radiographs, diagnostic casts and treatment plans
*Appliances for tooth guidance

Eligible orthodontic treatment is payable at 50%, and payments will begin once the bands are placed. Periodic payments will be made for eligible orthodontic services, provided eligible dependent remains in active treatment.

Coverage
Plan 1: Plan pays 50%
Plan 2: Plan pays 50%
Plan 3: No coverage
Plan 4: No coverage

 

$1100 lifetime maximum coverage for Orthodontia.

 

 

MAINE SCHOOL MANAGEMENT ASSOCIATION
49 Community Drive, Augusta ME 04330      Telephone: (207) 622-3473       Fax: (207) 626-2968

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updated on 07/23/2013