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Dental Benefits

What type of a dental program does the MBF offer?
How does the PPO Option work?
How much do I have to pay if I use a PPO Provider?
How can I locate a PPO provider?
How does the Out-of-Network benefit work?
How much do I have to pay if I use an out-of-network provider?
Which option is best for me?
What expenses are covered under the MBF Dental Plan?
Are pre-estimates of dental expenses required?
Is there a maximum limit on the benefit payable?
Will I lose coverage when I am no longer a member of the MBF?

 

What type of a dental program does the MBF offer?
The Fund Dental Plan offers services through a Participating Provider Organization (PPO) Option and an Out-of-Network reimbursement benefit.

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How does the PPO Option work?
Under the PPO Option, you select a panel dentist from either the Healthplex or MBF-SIDS Select PPO directories.  Members residing outside of NY, NJ, or CT will select a provider from the CONNECTION Dental Provider Organization.

Next, telephone the dentist to arrange an appointment identifying yourself as an eligible member or dependent of the Fund, and confirm that the dentist is a current PPO provider. At the time of the appointment, complete the member statement section of the claim form provided by the dentist.

Sign the claim form allowing the dentist to submit a pre-treatment estimate (when necessary) for confirmation from the Claims Administrator of the covered benefits in relation to the Plan; or, sign the form upon completion of services authorizing Fund payment directly to the dentist for services rendered.

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How much do I have to pay for covered services if I use a PPO Provider?
MBF members are responsible for deductibles and co-insurance, depending on the services received.

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How can I locate a PPO provider?
You can find a dentist online using the PPO directory, or you can call the Dental Claims Administrator and ask for a referral.

Use the Healthplex PPO directory online 
  (click "Find a Dentist" on the left-hand side of the page)
Use the CONNECTION Dental Provider Organization directory online
Visit the MBF-SIDS Select Web site (opens in new window) 

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How does the Out-of-Network benefit work?
When using an Out-of-Network provider, complete the employee's portion of the claim form for Dental Expense Benefits. Use a separate form for each member of your family. Follow the instructions given on the form. Have your dentist complete the dentist's portion of the claim form.
Send the completed form to the Claims Administrator:

Healthplex
333 Earle Ovington Boulevard, Suite 300
Uniondale, NY 11553-3608

Download the Claim Form (PDF)

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How much do I have to pay for covered services if I use an out-of-network provider?
MBF members are responsible for deductibles and co-insurance, and any amounts in excess of the Reasonable and Customary charge allowance, as determined by the Plan.

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Which option is best for me?
Each option has its own advantages. Using the PPO Option maximizes the value you derive from this plan because you receive covered services with some or no out-of-pocket costs. The Out-of-Network benefit offers you the convenience of selecting any provider with reimbursement paid to you subject to higher deductibles and coinsurance, at a maximum allowed fee (Reasonable & Customary charge) for the service.

You are always free to select and change your Dentist at any time, participating or non-participating, without notice.

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What expenses are covered under the MBF Dental Plan?
Benefits are payable for Covered Dental Charges incurred during a benefit year while eligible for these benefits. Covered charges include, but are not limited to, routine oral exams, extractions, fillings, crowns, oral surgery, root canal therapy, dental implants and orthodontics.


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Are pre-estimates of dental expenses required?
A treatment plan indicating a dentist's suggested treatment and charges is required for major services, orthodontic treatment and prosthetic procedures including:

  • Crowns
  • Dentures
  • Bridgework
  • Partials
  • Periodontal surgery
  • Implants

Pre-treatment estimates are required for the above services in excess of $250.  Pre-treatment estimates will provide both you and your dentist with actual coverage amounts before dental work begins. 

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Is there a maximum limit on the benefit payable?
Yes. The maximum amount of benefits payable for any one individual is $4,000* per Benefit Year. This limit applies to all covered services whether they are PPO or out-of-network, or a combination of both.

There is a separate lifetime maximum benefit of $4,000 payable per individual for orthodontic treatment.

*For services completed prior to January 1, 2012, the annual maximum is $2,500 and the lifetime orthodontic maximum is $2,500.

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Will I lose coverage when I am no longer a member of the MBF?
Under COBRA, you and your dependents have the right to continue coverage for a specified period from the time you are no longer a member.

If at the time you lost your membership you or your dependents were receiving covered dental treatment that was not completely finished, benefits will be paid for certain Covered Dental Charges incurred for the unfinished dental work for an extended period of three months after membership is lost.

Learn more about COBRA benefits

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Spotlight

Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

 Learn More
Quick Links

 PICA Program
 NYC Employee Blood Program
 Collective Bargaining Agreements
 OPA Web site
 NYC.gov