HMSA Dental
HMSA provides the Participating Provider Dental Program as described below. In addition, you also have dental coverage automatically through the Delta Dental plan.
Participating Provider Dental Program
To receive benefits, you must obtain services from a participating dentist.
- No annual deductible
- Calendar year maximum is $1,000 (this is the most that the plan will pay in a calendar year)
- Plan pays 100% for preventive care:
- Routine exams (two per calendar year)
- Cleaning (two per calendar year)
- Topical fluoride for children under age 19 (two per calendar year)
- Plan pays 70% for routine care:
- X-rays (periapical)
- Fillings
- Sealants on permanent molars
- Space maintainers
- Endodontics
- Periodontics
- Plan pays 50% for major care after a 12-month waiting period for new plan members):
- Crowns, bridges
- Dentures (partial upper or lower denture and complete upper or lower denture)
- Endosteal implants
- Orthodontic care is not covered
Calendar year rollover benefit
The calendar year rollover feature lets you roll over a portion of your unused dental benefits from year to year. For example, if you roll over $150 from 2012, your calendar year maximum for 2012 will actually be $1,150. The following rules apply to the calendar year rollover benefit:
- The maximum amount you can roll over each year is $350
- You must have had at least one dental service in the prior year
- The dental plan paid no more than $500 in benefits for the prior year
This information here is intended to help you understand the plan and how it works. It is not the official Summary Plan Description. To view the complete Summary Plan Description, please reference the HMSA Carrier Booklet, Delta Dental Carrier Booklet, and the CMSU Wrap SPD.