General Questions
1. Why is MCNA Dental Plans for you?
- No Charge - Oral Examination
- No Charge - X-Rays
- No Charge - Routine Cleanings (once every 6 months)
- No Charge - Fluoride Treatment
- No Charge - Local Anesthesia
- No Charge - Oral Cancer Screening
2. What other features and benefits do I get?
- Discount Prescriptions & Vision Benefits (optional on Group Plan)
- No Deductibles
- No Claim Forms
- No Annual Maximums
- No Age Limits
- No Exclusions for Pre-Existing Conditions
- No Limit on Replacing Missing Teeth
- No Pre-Authorization on Benefits Required
- Self Referral to Specialists
- Orthodontic (Braces) Coverage
- Cosmetic Dentistry Included
3. Who is eligible?
You, your spouse and legal dependents under the age of 19. Unmarried children, stepchildren, adopted children and legal wards may qualify as dependents. Dependents enrolled full-time in college or university programs are covered until age 25.
4. How do I join?
Simple, complete an enrollment form and mail it to us Today! It's that easy.
5. How do I receive care?
After your effective date, call the dentist you selected and tell the office that you have MCNA coverage. They will schedule you for an appointment to see the dentist.
6. How do I select my dentists?
When you enroll in the MCNA Dental Plan, you will be able to select a personal MCNA general dentist who will look after all your dental needs. You will choose from a list of affiliated area dentists who are supervised by the State Dental Board or the Agency for Health Care Administration.
7. How do I obtain specialty care?
When a specialist's care Orthodontics, Periodontics, Pedodontist, Prosthodontists, Oral Surgery or Endodontics), is needed, you may be referred by your participating general dentist, or you may refer yourself to any participating specialist listed in our directory. Specialist services are available only in areas where MCNA has a participating specialist. Payment for services performed by non-participating specialists is the responsibility of the member. Your cost for the service will be the specialist's usual and customary fee less 25%.
8. How do I change my dentist?
You may change your dentist by calling our Member Services Department and informing them of the desired change.
9. What are patient co-payments?
Co-payments are reduced fees that you pay directly to the dentist for some dental treatments.
10. Where can I print an ID card?
Please click on this link to print a replacement card.
11. Where can I learn more about dentistry?
Please visit the websites for the American Dental Association (www.ada.org) or the American Academy of Pediatric Dentistry (www.aapd.org).
12. What are the member rights and responsibilities?
- Dental Member's Rights and Responsibilities
- Receive the most current information about the dentist who participates with MCNA.
- Obtain necessary care from the participating dentist, or specialist (with a referral when applicable).
- Be advised by his/her dentist how to make appointments and receive dental care after office hours a back up dentist 24 hours a day every day.
- Call 911 in a situation that might be life threatening.
- Receive his/hers dental records when transferring to a new dentist.
- Be treated with respect for his/her privacy and dignity.
- Have his/her dental records kept private, except as otherwise required by law or with his/her approval.
- Dentist to help his/ her make decisions about dental care.
- Refuse any proposed dental treatment.
- Discuss with the dentist his/her condition and all care alternatives, including potential risks and benefits, even if a care option is not covered.
- Be informed that the dentist cannot be penalized for filing a compliant or appeal.
- Be informed that MCNA decides what benefits are covered. MCNA follows Florida Medicaid's Dental Services Coverage and Limitations handbook for Medicaid members.
- Be informed how MCNA pays the dentists.
- Receive current information about the services covered by MCNA what is covered and any applicable limitations or exclusions.
- Be informed about co-payments and fees, if any must be paid.
- Be informed on how to file a complaint, grievance, or appeal with MCNA.
- Receive a prompt reply from MCNA when asking questions or requesting information.
- The dentist needs to help in making decisions about the need for services and the complaint, grievance, and appeal process.
- Receive a copy of the Members rights and Responsibilities Statement.
- Members Have the Responsibility to:
- Follow the treatment directions and advise of the dentist.
- Inform the dentist of any unexpected symptoms as soon as they arise.
- Inform the dentist if he/she does not understand the treatment received and to ask how to care for the condition when not understood.
- Be informed that participating Dentist are not employed by MCNA and that MCNA does not have any control over them.
- Follow MCNA's complaint and appeal process if he/she believes he/she needs to submit a complaint or an appeal.
- Provide correct and complete information to dentists and any other health care providers who provide care.
- Treat dentist and staff and plans staff with respect.
- Inform MCNA of additional dental coverage that he/she or any family members may have.
- Not be involved in any dishonest activity directed to MCNA or any provider.
- Read and understand MCNA's benefits. Know what services are covered and what services are not.
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Explanation of Dental Services
1. Preventive Services
Covered services include: office visits for oral prophylaxis ( cleaning )
What this means: Oral prophylaxis to remove coronal plaque (bacteria on teeth), calculus and stains and includes scaling and polishing procedures.
2. Oral Examinations
Covered services include: office visits for a complete visual diagnosis of mouth, teeth and support structures.
What this means: this exam includes: recording the exam on paper, determining if there are cavities, pulp testing when indicated (this is referring to the blood vessels inside teeth), review of x-ray, written treatment plan.
3. Analgesia
Covered services include: the administration of a drug or agent to temporarily stop the feeling of pain in the conscious child.
4. Oral Surgery
Covered services include: the extractions, biopsies, surgical and adjunctive treatment of diseases, injuries, deformities, and defects of the oral and maxillofacial (of or relating to the upper jaw and face) areas.
What this means: coverage includes local anesthesia and routine post-operative care. Biopsies are the removal of tissue hard or soft, from the patient for examination under a microscope in order to make a diagnosis or plan treatment.
5. Palliative Treatment
Covered services include: services necessary to relieve pain and discomfort on an emergency basis.
6. Endodontic Services
Covered services include: office visits and treatment for pulp capping, therapeutic pulpotomies (the removal of the top portion of the blood vessels in the tooth), root canal therapy, apexification and acpicoetomies.
What this means: Root canal therapy on primary teeth with succedaneous teeth must include the placement of a resorbable filling. Apexification is the clinical treatment involving the necrosis of the pulp of incompletely formed deciduous and permanent teeth subsequent to trauma or dental caries (cavity). Apicoectomy is a surgery involving the root's surface.
7. Periodontal Services
Covered services include: gingivectomy, gingival curettage (gum scraping to remove bacteria), gingival flap procedure, scaling and root planning. Services also include any necessary postoperative care.
What this means: Gingival curettage is the surgical procedure of debriding (or Surgical excision of dead, devitalized, or contaminated tissue and removal of foreign matter from a wound) the soft tissue wall of the periodontal pocket by curettage.
8. Orthodontic Services
Covered services include: fixed appliance therapy and monthly maintenance visits.
What this means: this service must be given by a trained orthodontist or pediatric dentist.
9. Radiographic Examination (x-rays)
Covered services include: intraoral, extraoral and panoramic radiographs necessary to make a diagnosis of dental disease or trauma.
What this means: this service must determine if the child has cavities, retained roots and unerupted teeth, foreign bodies or root and other disease.
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