DENTAL INSURANCE PROGRAM
Dental insurance is a limited benefit (not like your medical insurance where something could be medically necessary).
What is the yearly benefit?
The calendar year (January through December) provides benefits of up to $1,250.
What if I am changing dentists?
Because there is no network, you can go to any dentist in or out of the state of Maine. If the dentist won’t bill the insurance on your behalf then you can be reimbursed for any eligible claims.
Do I need to wait for my benefits to start after my effective date?
There are no waiting periods.
What are some of the limitations under the preventive benefit?
Sealants are only covered for dependents under the age of 15, permanent molar teeth only, applied once only.
Fluoride treatments are for dependents under the age of 19, one in a twelve-month period.
Exam, cleanings, and bitewing x-rays are provided twice a year (unless the calendar year benefit has been exhausted).
Are there any orthodontic benefits?
There is $1,100 for orthodontic benefits for dependents under the age of 19 under plans 1 or 2.
Until what age are my children covered?
They can be covered up to age 26. No proof of dependent status is required.
What about when I terminate employment or retiree?
MSMA administers COBRA and retiree benefits.
Benefit can be taken into retirement with no reduction in benefit; you can either receive an individual bill or have the monthly premium deducted from your MePERS pension.
Who do I call if I have questions on my plan?
You can call either MSMA (207) 626-5444 or Patient Advocates, LLC (1-800-290-8559) for any benefits questions. If you have claims questions you will need to contact Patient Advocates, LLC.