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Dental

Dental coverage is a core benefit for state of Montana employees. As a core benefit, dental coverage is required for all employees enrolled in the state benefit package. The plan covers most preventive, restorative, and major dental procedures. Orthodontia benefits are not covered. There is a $50 per member, $150 per family deductible for Type B and C services only (see below).

This type of plan generally allows you to see any licensed provider. However, if you use a Blue Cross and Blue Shield of Montana participating dentist, you will not be responsible for costs beyond the allowable charges for covered services. For the most current participating provider listings, go to www.bcbsmt.com or call (800) 423-0805. Non-participating and out-of-state dentists can bill for the amount over the Blue Cross and Blue Shield of Montana allowable charges.

 

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Eligibility

Employees, legislators, retirees, COBRA members, and eligible dependents (spouse, domestic partner, and children) are eligible for the dental plan. Employees are required to be enrolled in dental coverage unless they waive the entire benefit package.

Dental Payments for Benefits

Coverage Tier Monthly Payment for Benefits Bi-Weekly Contribution
Member Only $34.90 $17.45
Member and Spouse $53.12 $26.56
Member and Children $51.58 $25.79
Member and Family $59.36 $29.68
Joint Core $40.74 $20.37

The Internal Revenue Service requires the State of Montana to apply the proper tax treatment (before or after tax) to payments for benefits paid for your spouse or domestic partner enrolled in dental benefits. Whether your contribution is deducted on a before or after tax basis depends on whether your spouse or domestic partner is qualified or non-qualified for tax purposes. To help you determine your spouse or domestic partner's tax status, we have made several reference materials available. 

Covered Services

Dental plan benefits are paid based on the type of service received. There is a $50 per member, $150 per family deductible for Type B and C services only. The deductible does not apply to Type A preventive services. Each member and dependent has a maximum calendar year benefit of $1200 for Type B and C services only.

Covered Services Plan Pays Limitations/Maximums
Type A: Preventive and Diagnostic 100% One full-mouth X-ray or series in any 36-month period
    One set of supplementary bitewing X-rays in any 180-day period
   

Two exams and/or cleanings in any benefit year (Fluoride application covered through age 16);

Dental sealants – limited to covered dependents under age 16 – may be applied to molars once per tooth per lifetime.
    No deductible or yearly dollar maximum apply
Type B: Fillings, Oral Surgery, etc. 80% Subject to $50 combined (with type C) deductible
    Subject to $1200 combined (with type C) yearly maximum
Type C: Dentures, Bridges, etc. 50%** Subject to $50 combined (with type B) deductible
    Subject to $1200 combined (with type B) yearly maximum
     
**The plan will pay up to the allowed amount or the maximum allowable charge for in-network providers. You can be balance billed by out-of-network providers for any amount that exceeds the allowable amount. Network providers cannot balance bill you for the difference between their charges and the plan’s allowed amount.

Type A Services - Preventive Services

The Dental Plan pays 100 percent of the allowable charges for Type A Services (not subject to deductible):

  1. Diagnostic – Dental X-rays required in connection with the diagnosis of a specified condition requiring treatment. Dental X-rays are limited to one full mouth X-ray or series in any 36-month period and not more than two sets of supplementary bitewing X-rays in any benefit year
     
  2. Preventive – Oral examination, including prophylaxis (cleaning) and topical application of fluoride for dependent children under 16 years of age, but not more than two examinations and/or applications in any benefit year
  3. Dental sealants, limited to covered dependents under age 16 applied to molars once per tooth per lifetime. Repair and resealing are not covered
     
  4. Unscheduled minor emergency treatment to relieve pain

Type B Services - Basic Services

The Dental Plan pays 80 percent of the allowable charges (after deductible) for Type B Services:

  1. Passive space maintainers
     
  2. Extractions
     
  3. Fillings consisting of silver, amalgam, silicate, and plastic. Two or more fillings on the same surface are considered one procedure even though the fillings are not in contact with each other
     
  4. Mucogingivoplastic surgery, management of an acute infection, and oral lesions
     
  5. Endodontics – the diagnosis and treatment of disease of the dental pulp (i.e. root canals)
     
  6. Periodontics - the diagnosis and treatment of diseases of tissues around the teeth
     
  7. Oral surgery
     
  8. General anesthesia (prior authorization recommended to assure coverage) performed by a physician/anesthesiologist, dentist, or by a nurse anesthetist for oral surgery, teeth extraction, or when certified as medically necessary by the attending dentist
     

Type C Services - Extensive Services

The Dental Plan pays 50 percent of the allowable charges (after deductible) for Type C Services:

  1. Crowns, bridge abutments (bridge retainers crowns), inlays, onlays, pontics and gold and porcelain fillings. Replacement of crowns is limited to once every five years.
     
  2. Bridges
     
  3. Repair and rebasing of existing dentures
     
  4. Initial and replacement dentures, limited to no more than one set of replacement dentures in any 5-year period.
     
  5. Up to $1,500 per person, per lifetime for dental implants while under the plan. This maximum is separate from the yearly maximum
     

Contact Blue Cross and Blue Shield

Blue Cross and Blue Shield, (800) 423-0805 or (406) 444-8315

www.bcbsmt.com