OEBB

Dental benefits

Is a brush biopsy covered under the dental plan?

Yes, brush biopsy is covered once in a six-month period. However, the lab fees are covered under the medical plan.

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Is fluoride covered under the dental plan?

Fluoride is covered once in any six-month period until the age of 19. Fluoride is covered for members age 19 and older only if there is a history of periodontal disease or a high risk of decay because of medical disease, chemotherapy or a similar type of treatment (not because of poor diet or oral hygiene).

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Are sealants covered under the dental plan?

Sealants are covered on the unrestored, occlusal surfaces of permanent molars once per tooth every five years.

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How often are crowns allowed?

Cast restorations (crowns and onlays, including replacements) are covered once every seven years per tooth.

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How often are bridges and dentures allowed?

Removable and fixed prosthetics (partials, dentures, bridges) are covered once every seven years.

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Are implants covered under the dental plan?

Yes. Implants are covered under the prosthodontic services category. The Member Handbook provides detailed information on implant benefits.

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What are the dental benefits when traveling or for dependents residing outside the service area?

Through Moda Health's partnership with Delta Dental, OEBB members who reside out of state have access to any of the more than 151,000 Delta Dental providers nationwide.

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How does an incentive dental plan work (OEBB Plans 1 and 5)?

Under an incentive dental plan, benefits start at 70 percent during the first plan year of coverage. Thereafter, payments increase by 10 percent each plan year (up to a maximum benefit of 100 percent) provided that the member has visited the dentist at least once during the previous plan year. Failure to do so will cause a 10 percent reduction in payment the following plan year, although payment will never fall below 70 percent.

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How often are cleanings allowed?

Prophylaxis (cleaning) or periodontal maintenance is covered once in any six-month period.

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Do OEBB members have the Oral Health, Total Health benefit?

Yes. Diabetic members enrolled in the Oral Health, Total Health program are allowed a total of four prophylaxes or periodontal maintenance sessions in a benefit year. Pregnant women in their third trimester may be eligible for an additional cleaning. Members can contact Moda Health Dental Customer Service for enrollment information.

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Is there a deductible on the dental plan?

Yes. There is a $50 deductible on all Moda Health dental plans. The deductible is waived for preventive services.

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If a member moves from one incentive plan to another incentive plan, will the incentive level follow them?

Incentive credit will be given and the annual maximum and deductible will carry over for members transferring from one incentive group to another incentive group within OEBB if lapse in coverage is 31 days or less. Members who renew their eligibility over 31 days from their prior coverage start at 70% incentive level and will receive new annual maximum and deductible.

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If a member moves from a constant plan to an incentive plan, will the incentive level follow them based on the dental services they received?

No. If current OEBB members move from a constant plan (Plan 6 or the Exclusive PPO plan) to an incentive plan (Plans 1 or 5) their incentive level starts at 70 percent, regardless of their original date of hire.

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How is the incentive level affected if member has a lapse (break) in coverage of more than 31 days?

If a member has a lapse (break) in coverage of more than 31 days, the incentive level will begin again at 70 percent.

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If a member has dual Moda Health dental coverage under OEBB, does the maximum benefit double as well? For example, if two members (husband and wife) have dental Plan 5, is their total maximum of $3,400 per member per plan year in lieu of the $1,700 per member per plan year?

If a member has dual Moda Health coverage under OEBB with a plan maximum (e.g., dental plan with $1700 plan-year maximum), the primary plan will pay first. The secondary plan will pick up balances on allowable expenses. Once members have met their maximum on the primary plan ($1700 has been paid out), then the secondary plan will pay, as if it is primary, until it too has met the $1700 maximum. (Dollars paid as secondary, prior to the primary maximum being met, also apply toward the secondary $1,700 maximum).

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If members have dual Moda Health dental coverage under OEBB through Moda Health and their dentist charges more than the usual and customary allowable, will the other policy pick up the remainder of the charges through coordination of benefits?

Moda Health, as the secondary plan, will pay up to the highest allowable not to exceed the billed amount. If a husband and wife both have Moda Health dental coverage under OEBB, the allowed amount will be the same for both plans. If there is a charge over the allowed amount, members would still be responsible for the extra charge. When a member visits a dentist that is in the Moda Health premier network, the member will not be billed for charges over the contracted fees because, as a participating provider, the provider will write off the amount that is billed over the contract allowance.

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