Indemnity Plan

If you enroll in the MPE Indemnity Plan, you may receive dental treatment from any licensed general dentist or specialist you select. The dental procedures covered and amount reimbursed are listed in the Indemnity Plan reimbursement schedule.

The Fund’s Indemnity Plan is administered by Delta Dental of Massachusetts. As such, Fund members are able to take advantage of some of the benefits offered to Delta Dental members. Your out-of-pocket costs may differ based on whether the dentist you select participates in Delta Dental in Massachusetts, Delta Dental outside of Massachusetts, or does not participate with Delta Dental. It is your responsibility to confirm your dentist’s participation with Delta Dental.

If you are enrolled in the Indemnity Plan and your dentist participates in Delta Dental:

  • Delta Dental manages the Delta Dental Premier network and the Delta Dental PPO network. If your dentist participates in one of these networks, s/he agreed to accept a fee for service that is determined by Delta Dental of Massachusetts. You are responsible for the difference between the the Fund’s Indemnity Plan reimbursement schedule and this fee. If your dentist is a “participating Delta Dental PPO provider”, the savings to you may be greater.
  • Your dentist will submit the claim directly to Delta Dental of Massachusetts.
  • You will receive an Explanation of Benefits (EOB) form after your claim is filed by your participating dentist. The patient payment column of the EOB shows the amount you owe your dentist.

If you are enrolled in the Indemnity Plan and your dentist does not participate in Delta Dental:

  • You must pay your dentist directly.
  • You must submit a claim form to Delta Dental of Massachusetts, and Delta Dental of Massachusetts will reimburse you directly.
  • You can obtain claim forms by calling the MPE Unit at Delta Dental of Massachusetts at (800) 553-6277. Completed claim forms should be submitted to:

MPE Claims
PO Box 2907
Milwaukee, WI 53201-2907

Your plan has a $1,600* annual plan maximum for each family member each Plan Year. Payments for preventive, diagnostic, periodontal scaling and root planing, orthodontic treatment, and immediate or complete dentures are not deducted from this annual maximum. There is also a separate annual plan maximum of $1,175* for the surgical placement of an implant.

If you are enrolled in the Indemnity Plan and your dentist participates in the MPE Exclusive Provider Network (EPN) Plan, you are subject to the above Indemnity Plan guidelines.

*Commonwealth of Massachusetts Seasonal Employee annual plan maximum is equal to 50% of stated maximum