messa – delta dental · messa account: employee group: group/subgroup: plan guidelines messa...

MESSA Account: Employee Group: Group/Subgroup: Plan Guidelines MESSA dental plans are underwrien and administered by Delta Dental of Michigan, a non-profit dental care corporaon known for its high quality dental programs. Delta Dental contracts with densts throughout the U.S. to provide high quality care and 90% of Michigan densts are in the Delta Dental provider network. MESSA members can easily locate Delta Dental contracng providers by vising www.messa.org and using the provider directory search provided by Delta Dental. • Necessary treatment and procedures required for the correcon of abnormal bite. • Orthodonc exam, radiographs and extracons are covered under Diagnosc & Prevenve Services and Basic Services. RIDER (If the box below is not checked, you do not have this coverage.) For a complete lisng of exclusions and limitaons that apply to the plan, refer to the Delta Dental of Michigan cerficate booklet. Diagnosc & Prevenve Services ______ % Basic Services ______ % Major Services ______ % Orthodoncs ______ % • Oral Examinaon • Prophylaxes • Topical Fluoride* • Brush Biopsy • Emergency Palliave • Two Cleanings in 12 Months RIDER (If neither box below is checked, you do not have this coverage.) *Fluoride treatments are payable twice in any period of 12 consecuve months for people up to age 19. • Radiographs (x-rays)* • Restorave • Crowns** • Oral Surgery • Endodonc Services — treatment for diseased or damaged nerves. • Periodonc Services — treatment for diseases of the gum and teeth- supporng structures. * Bitewing x-rays are payable once in any period of 12 consecuve months. Full mouth panograph is payable once in 5 years. ** Payable once in any five-year period on the same tooth. RIDER • Procedures for the construcon of fixed bridgework, endosteal implants, paral and complete dentures. • Payable once in any 5 year period for the same appliances. $ annual maximum per person Diagnosc & Prevenve Services, Basic Services, and Major Services $ lifeme maximum per person Orthodoncs Sealants — payable on occlusal surface of first permanent molars for paents up to age nine and for second permanent molars for paents up to age 14 that are free from caries and restoraons. 3 Cleanings in 12 Months Adult orthodoncs: removes the age 19 restricon on Orthodoncs coverage. 4 Cleanings in 12 Months (If the box below is not checked, you do not have this coverage.) MES - FS Rev. 1/30/18 Pr. 1/18 - 1 PDF MESSA Dental Plan Benefit Highlights Effecve Date:

Upload: phungtu

Post on 12-Apr-2019

213 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

MESSA Account:

Employee Group: Group/Subgroup:

Plan Guidelines

MESSA dental plans are underwritten and administered by Delta Dental of Michigan, a non-profit dental care corporation known for its high quality dental programs. Delta Dental contracts with dentists throughout the U.S. to provide high quality care and 90% of Michigan dentists are in the Delta Dental provider network. MESSA members can easily locate Delta Dental contracting providers by visiting www.messa.org and using the provider directory search provided by Delta Dental.

• Necessary treatment andprocedures required for thecorrectionofabnormalbite.

•Orthodonticexam,radiographsandextractionsarecoveredunderDiagnostic&PreventiveServicesandBasicServices.

RIDER(Iftheboxbelowisnotchecked,youdonothavethiscoverage.)

Foracompletelistingofexclusionsandlimitationsthatapplytotheplan,refertotheDeltaDentalofMichigancertificatebooklet.

Diagnostic & Preventive Services______ %

Basic Services______ %

Major Services______ %

Orthodontics______ %

•OralExamination•Prophylaxes•TopicalFluoride*•BrushBiopsy•EmergencyPalliative•TwoCleaningsin12MonthsRIDER(Ifneitherboxbelowischecked,youdonothavethiscoverage.)

*Fluoride treatments are payable twice in any period of 12 consecutive months for people up to age 19.

•Radiographs(x-rays)*•Restorative•Crowns**•OralSurgery•EndodonticServices—

treatment for diseased or damagednerves.

• PeriodonticServices—treatment for diseases of thegumandteeth-

supportingstructures.

*Bitewingx-raysarepayableonceinanyperiodof12consecutivemonths.Fullmouthpanographispayableoncein5years.

**Payableonceinanyfive-yearperiodonthesametooth.

RIDER

• Proceduresfortheconstructionoffixedbridgework,endostealimplants,partialandcompletedentures.

• Payableonceinany5year period for the same appliances.

$ annualmaximumperpersonDiagnostic & Preventive Services, Basic Services, and Major Services

$ lifetimemaximumperpersonOrthodontics

Sealants—payableonocclusalsurfaceoffirstpermanentmolarsforpatientsuptoagenineand for second permanent molarsforpatientsuptoage14thatarefreefromcariesandrestorations.

3Cleaningsin12Months Adultorthodontics:removestheage19restrictiononOrthodonticscoverage.4Cleaningsin12Months

(Iftheboxbelowisnotchecked,youdonothavethiscoverage.)

MES - FSRev. 1/30/18Pr. 1/18 - 1 PDF

MESSA Dental Plan Benefit Highlights

Effective Date:

Delta Dental Presentation

Delta Dental Savings PPO - Wisconsin’s No. 1 dental plan · PDF fileDelta Dental Savings PPO Delta Dental Savings PPO An affordable plan that leverages Delta Dental’s huge PPO

Toothpic - Delta Dental

Delta Dental’s Federal Employees Dental Program - … · Delta Dental’s Federal Employees Dental. ... Delta Dental maintains the network of ... Delta Dental's Federal Employees

Ccsnys Delta Dental Presentation

Delta Dental networks - multco.us

Delta Dental PPO - Human Resources University of Michigan · Delta Dental PPO . Our national . Point-of-Service . program . University of Michigan Dental Plan . Welcome! Delta Dental