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FAQs
Dental - Frequently
Asked Questions
How many times do I have to fill out one of those medical update
forms?
The Plan requires that an
Annual Medical/Dental Update Form be updated
once every twelve months or whenever the
patient’s information changes. For example, the form should be
updated when a spouse’s medical insurance changes through his or her
employer. If you cannot remember when each family member’s form
expires, and you anticipate using the Plan within the year, you may
download the form in January and fill one out for each covered
family member.
An updated
Annual Medical/Dental
Update Form for
the patient must be on file at the Administrative Office for any claims to be
processed. If the Annual Medical/Dental Update Form is not current,
the participant will be requested to fill one out and the claim will
be not be paid until the form is completed. The most common
cause for a delay in processing a claim is that the patient does not
have a current Annual Medical/Dental Update Form on file.
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How long do I have to
file a claim?
The Plan accepts claims for medical services
for twelve months from the date of service.
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Is there a Preferred Provider (PPO) for dental services?
The Plan has no preferred providers for dental services, nor does it
maintain a referral list of dentists. You may go to the dentist of
your choice.
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Is
fluoride treatment a covered expense for adults?
Yes, all participants and dependents are allowed one fluoride
treatment per year.
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My routine cleanings and exams were only 5 months apart - will
the Plan still pay for them? Do they have to be six months apart?
Participants
and dependents are allowed two cleanings and exams within a calendar
year, they do not need to be six months apart.
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Will the Plan pay for a cosmetic treatment I need for my teeth?
No, the Plan will not pay for treatments or services which are
primarily for cosmetic purposes.
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Are fluoride toothpaste or other home health care products I need
covered under the plan?
Flouride toothpaste and other health
care products designed for use at your home are not covered expenses
under Plan.
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What dental treatments or procedures do I need to have pre-authorized?
No, pre-authorization
is not required for any dental services. However,
intravenous sedation is
covered only when
treatment warrants the sedation. If you are unsure whether your
treatment warrants sedation, you or dentist may call for
pre-authorization.
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I need to travel to
another town to have some dental work done. Will the Plan pay
for
my travel expenses?
No, the Plan does not cover travel expenses for dental services.
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What does it mean my charges exceeded the " usual and customary"?
Usual and customary charges are the average charges for
designated services provided in a particular area. This information
is gathered continuously by a national service. The
Administrative Office
receives an update every six months. Should your provider charge
in excess of the usual and customary, you are responsible for all of
the amount over the usual and customary.
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Is
nitrous oxide covered under the Plan?
Nitrous oxide is a covered expense only for dependent children age 12
and under. It is not covered for those over the age of 12.
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What types of sedation are covered under the dental plans?
Nitrous oxide is covered for dependent children age 12 and under.
Intravenous sedation is covered only if treatment warrants that type
of sedation. As a rule, general anesthesia is not a covered expense.
Contact the Administrative Office if you have questions regarding sedation and
anesthesia coverage.
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