Medical Mutual Dental Option

Medical Mutual has partnered with DenteMax, a preferred provider network of independent dentists who accept a set discounted fee for dental services. Although the NCSC dental plan is a "traditional" plan, Medical Mutual members can take advantage of the DenteMax network.

Dentists within the preferred provider network have agreed to accept DenteMax's discounted fee schedule - after applicable co-pays and/or coinsurance. Further, DenteMax dentists have agreed not to balance bill for covered services so your out-of-pocket expenses are reduced. For a list of participating dentists in the area go to www.dentemax.com.

If a dentist is not in the preferred provider network, Medical Mutual pays the dentist a "usual and customary" amount; the patient is responsible for the difference between the amount charged by the dentist and the "usual and customary" amount.

Benefits

  
Benefit Period January 1st through December 31st
Dependent Age Limit 19-Dependent  24-Student
Removal upon end of calendar year
Benefit Period Maximum (per member) $1,000
Benefit Period Deductible (single/family)¹ $50/$100
Orthodontic Lifetime Maximum (per eligible
dependent up to age 19)		 $1,000

Preventive Services

  
Oral Exams - two per benefit period 100%
Bite Wing X-Rays - two sets per benefit period 100%
Prophylaxis (cleaning) - two per benefit period 100%
Fluoride Treatment - two treatments per benefit period 100%
Space Maintainers - limited to eligible
dependents up to age 19		 100%
Emergency Palliative Treatment - includes
emergency oral exam		 100%

Essential Services

  
Sealants - one every 36 months for eligible dependents up to age 19 80% after deductible
Consultations and Other Exams by Specialist 80% after deductible
Diagnostic X-Rays - including Full Mouth/Panorex,
which are limited to one every 36 consecutive months		 80% after deductible
Minor Restorative Services 80% after deductible
Endodontics/Pulp Services 80% after deductible
Periodontal Services 80% after deductible
Repairs, Relines & Adjustments of Prosthetics 80% after deductible
Simple Extractions 80% after deductible
Impactions 80% after deductible
Minor Oral Surgery Services 80% after deductible
General Anesthesia 80% after deductible

Complex Services

  
Gold Foil Restoration 50% after deductible
Inlays, Onlays - one every five years 50% after deductible
Crowns - one every five years 50% after deductible
Bridgework (Pontics & Abutments) - one
every five years		 50% after deductible
Partial and Complete Dentures - one
every five years		 50% after deductible

¹ Maximum family deductible. Member deductible is the same as single deductible. 3-month carryover applies.

Benefit information for: Orthodontic Services

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