Milwaukee County sponsors a prepaid fully insured dental maintenance organizations (DMO), Care-Plus, in addition to the DMO plan, a self-insured fee-for-service dental plan is also available. The self-insured dental plan has a $2,500 per person per plan year maximum benefit. Some oral surgeries may be covered under your medical plan.
The Dental Plans have similar regulations and procedures as the health plans regarding eligibility, enrollment, dependent enrollments, insurability, open enrollment, and continuation of coverage.
Milwaukee County does not provide a retiree dental plan. Retirees can continue their coverage under the Federal COBRA law for up to eighteen (18) months by paying the full Premium of the plan.
Dental Plan Features
For details concerning each Milwaukee County dental plan, review the benefit booklet for a comparison of Dental plans. There is a plan-by-plan comparison of the different benefit levels available through each plan.
Before enrolling, think through your dental care needs when considering your dental plan options. Once enrolled, you cannot change your plan until the next open enrollment period.
Dental Enrollment Cards
ID cards are proof of your enrollment, and are sent to you about three to four weeks after the effective date of your coverage, if you are newly enrolled. Cards are mailed directly from the dental carrier you selected. If you need additional cards, request them directly from the dental care plan you have selected. Please present this card whenever you request services from a dentist as it will speed up claim processing.
If you enrolled in a DMO, you should not have to complete claim forms.
If you enrolled in the self-insured dental plan, you can obtain claim forms from the claims payer's office by phoning 1-800-236-3712. Generally speaking, your dentist will submit claims directly to the claims administrator if you show the office your dental enrollment card with billing information on it. If you must submit a claim, please provide all the information requested on the claim form as it will speed up claim processing. All claims should be submitted as soon as possible after services have been rendered.
All covered charges will be subject to your individual deductibles. Once you have met the deductible, the claims administrator will make the appropriate payment directly to the provider.
You will receive an Explanation of Benefits (EOB) from the claims administrator in the mail. It is always a good practice to compare this EOB with any statements you have received. This helps you to determine what portion of the bill remains to be paid by you directly to the dentist. EOBs also provide proof of dental expenses for tax purposes.
Oral surgery benefits are payable for oral surgical procedures and surgical extractions of impacted teeth not covered under your medical plan. If you are enrolled in a DMO and your dentist recommends oral surgery, contact the UnitedHealthcare customer service department at 1-800-603-3941 for further clarification. You will have to use specific providers for oral surgery.
Coordination of Benefits
When a claim arises, and your family has more than one plan, submit the claim to the primary dental carrier. If you have a question about who is the primary dental carrier, see the points below.
If the County claims administrator determines that another carrier is the primary carrier for your claim, the claim will be rejected and you may submit it to a different dental carrier.
At least once a year the County claims administrator will contact you by mail to determine if any other family members have dental insurance in order to properly minimize the County's dental costs. You will also be contacted annually regarding the eligibility of dependents aged 19-25.
To help you determine who are the primary and secondary payers when both husband and wife are employed outside the home and both have dental coverage, the following rules apply:
1. The employer's coverage is always primary on its employee.
2. Dependent Children. Payment order is based on birthdays rather than the gender of parents. This means that the plan of a parent with a birthday (month and day, not year) which occurs first in the calendar year will be the primary plan, i.e., pay its benefits first. Exceptions to the birthday rule determination will occur if:
3. Another plan covering the children (for example a contract issued in another state) does not contain the birthday rule. In this situation, the plan of the male covering the children will pay its benefits before the plan of the female.
4. Parents are divorced or separated. In this situation, the plan of a mother or stepfather with custody, or the plan of a parent with court ordered financial responsibility, will pay its benefits before the plan of the other parent.
If you sustain a claim due to an illness or injury caused by another party, or as a result of a work related illness or injury, your dental plan will attempt to collect their paid claim expenses from the insurance carrier of the other party.
You must inform the County carrier of such instances. It is required that you cooperate with the claims administrator or DMO in providing the necessary information in order for the plan to complete its investigation. This is handled the same way as a homeowner's or renter's liability policy would be handled.
Prior to getting extensive dental work, it is a good idea to obtain pre-certification of the treatment plan by the insurance company.