- Can I change my plan?
- What is the MPE Fund Plan? I thought I had a Delta Dental Plan.
- Can I remove my ex-spouse?
- I am in the MPE EPN plan and my dentist is not. Can I submit the claims for reimbursement?
- I left my job. Can I continue coverage?
- You did not have my current address on file. Why?
- My dependent who attends college full-time is not listed as eligible on my plan and the claim was denied. What can I do?
- I have used my entire available annual plan maximum. What can I do?
- Will my child’s orthodonic coverage continue if I change from the EPN to the Indemnity plan?
- I just became eligible and my child is already in braces. Is treatment covered?
- Can I choose the Indemnity Plan for me and the EPN Plan for my spouse?
- My spouse and I are both eligible for the MPE Fund Plans. Can we be on each other’s plans?
- How can I find out if my Vision Care Provider participates in my plan?
Can I change my plan?
Question: I never received a Plan Booklet or enrollment form when I first became eligible for the Fund’s dental and vision plan. I now need services but my dentist does not participate in the MPE Exclusive Provider Network (EPN) Plan. Can I change my plan?
Answer: All members are sent eligibility information approximately two months prior to their effective date of coverage so that they have time to enroll dependents and select a dental plan. If the enrollment form is not returned by the effective date of coverage, members are automatically enrolled in the MPE Exclusive Provider Network (EPN) Plan. You may add eligible dependents any time during the year. However, you will have to wait until the Fund’s Open Enrollment period to change your dental plan.
What is the MPE Fund Plan? I thought I had a Delta Dental Plan.
Question: I recently called your office and was told my coverage is under the MPE Fund plan. I thought I had a Delta Dental Plan, which my dentist accepts. What’s the difference?
Answer: Your dental benefits are with the Massachusetts Public Employees Fund. The Fund retains Delta Dental of MA, a third-part administrator, to process and pay dental claims according to all the policies and guidelines established by the Trustees of the MPE Fund. The MPE Exclusive Provider Network (EPN) is a unique network of dentists that participate in the MPE Fund plan. They may, or may not, also participate in a Delta Dental plan. In the Fund’s Indemnity Plan, you may go to any dentist you choose, however your out-of-pocket expenses may be lower if that dentist is also a Delta Dental Preferred Provider (PPO) office. Please read the booklet carefully to ensure you are enrolled in the correct plan to receive coverage.
Can I remove my ex-spouse?
Question: I am divorced and my ex-spouse is still listed on my plan. Can I (Must I) remove his/her coverage?
Answer: The Fund will will terminate coverage for an ex-spouse when: your divorce is final and either you or your ex-spouse remarries; or your divorce is final and the divorce decree specifically states that you are not responsible for providing dental coverage to your ex-spouse; or your ex-spouse has the opportunity to participate in another dental plan (i.e. dental coverage offered through his/her employer). You or your ex-spouse must notify the Fund in the event of a divorce, remarriage or change in dependent status within 60 days of the date on which coverage would terminate.
Please note: You do not pay for this benefit, nor do you pay when dependents are eligible on your plan. This benefit is 100% employer funded. Additionally, the Fund is not subject to your court or divorce agreement, so even if your divorce decree may state that you must continue to cover your ex-spouse, if one of you remarries, or your ex-spouse is eligible to participate in another dental plan, he/she will not be eligible for this benefit.
I am in the MPE EPN plan and my dentist is not. Can I submit the claims for reimbursement?
Question: I am enrolled in the MPE Exclusive Provider Network (EPN) Plan and I went to a dentist that apparently does not participate in the MPE EPN Plan. Can I submit the claims for reimbursement?
Answer: There is no out-of-network coverage. You must read Your Dental Care Options section of your annual plan booklet to understand your responsibilities before receiving treatment.
I left my job. Can I continue coverage?
Question: I left my job and never received a Continuation Coverage Election Form. Can I request coverage now?
Answer: You are eligible to elect continuation coverage only if 60 days has not lapsed from your termination date or the date the form was sent to you by the Fund to the address we have on file, whichever is later. If you have left your job recently, or have another “qualifying event” as described in the Continuation Coverage section, you should contact the Fund office to ensure that your eligibility is up-to-date.
You did not have my current address on file. Why?
Question: I have moved, but when I recently called your office you did not have my current address on file. Why?
Answer: The Fund receives most member information on electronic files directly from your employer. You must notify your personnel office of any updates to your address to ensure that the file the Fund receives contains the most recent information.
My dependent who attends college full-time is not listed as eligible on my plan and the claim was denied. What can I do?
Question: I have a dependent that attends college full-time, however they are not listed as eligible on my plan and the claim was denied. What can I do?
Answer: It is your responsibility to ensure that the college submits a Verification of Student Status to the Fund each semester. You can download a form at Student Verification Form or call the Fund office for a form. When the Fund receives appropriate verification, we will reinstate coverage retroactively, if appropriate. After coverage has been reinstated you must contact the MPE Unit at (800) 553-6277 to request that the claim be reprocessed. Please see page 4 for more details.
The MPE Fund is not required to comply with the Patient Protection and Affordability Care Act.
I have used my entire available annual plan maximum. What can I do?
Question: I have used my entire available annual plan maximum. Can I roll over my unused balance from a prior year or ‘borrow’ from my spouse’s available balance for the additional treatment I need?
Answer: Your annual plan maximum cannot be transferred or carried over to another year. You should remember, however, that preventive and diagnostic services, periodontal scaling and root planing and immediate and complete dentures are no longer deducted from your available plan maximum, so you can receive those services at any time, subject to all other limitations such as frequency.
Will my child’s orthodonic coverage continue if I change from the EPN to the Indemnity Plan?
Question: My family is enrolled in the MPE Fund Exclusive Provider Network (EPN) Plan. My son is undergoing orthodontic treatment. Will he still receive coverage if we switch to the Indemnity Plan during Open Enrollment but before his treatment is completed?
Answer: There will be no additional benefits payable if you change your plan if the Fund has already made payments that exceed the orthodontic benefit under the Indemnity Plan, which is $1,200.
I just became eligible and my child is already in braces is treatment covered?
Question: I had dental coverage with my former employer, and my child is in braces. When I become eligible for the MPE Fund Vision and Dental Health Plan, will the Plan pay anything for my child’s remaining orthodontic treatment?
A: There is no coverage for orthodontic treatment that commenced prior to a member’s eligibility with the MPE Fund.
Can I choose the Indemnity Plan for me and the EPN Plan for my spouse?
Question: My dentist does not participate in the MPE Exclusive Provider Network (EPN) Plan, but my spouse’s dentist does. Can I elect the Indemnity Plan for me and the EPN Plan for my spouse?
Answer: All family members must be enrolled in the same plan. The only exception to this rule occurs when two or more family members are individually eligible for Fund benefits. In these cases each eligible member may enroll in a different plan.
My spouse and I are both eligible for the MPE Fund Plans, can we be on each other’s plans?
Question: My spouse and I both work for the same employer and have coverage under the MPE Fund Vision and Dental Health Plans. Can we both be enrolled in each other’s plan and is there any benefit to doing that?
Answer: You can both be enrolled in the other’s plan and you can coordinate benefits. Remember, the dental and vision plan is fully funded by employer contributions, so there is no additional cost for enrolling dependents. Please contact the MPE Fund office at (800) 325-5214 for more information.
How can I find out if my Vision Care Provider participates in my plan?
Question: The Vision Care Providers are not listed in the member handbook. How can I find out if my provider still participates?
Answer: You may call Davis Vision at (800) 406-1656 or visit www.davisvision.com to obtain a recorded list or a printed list, whichever you prefer.