Frequently Asked Questions

How do I enroll in the MCHCP Delta Dental plan for state employees?

You can enroll on the MCHCP web site at www.mchcp.org. Log onto myMCHCP by entering your MCHCPid or Social Security number for access. Open enrollment takes place October 1-31. Once enrolled, you will receive your ID card in December, containing your household's primary subscriber's name. You can request additional ID cards from Delta Dental online, by phone or by mail.

If I already enrolled last year, or the previous year, with Delta Dental, do I need to re-enroll this year?

If you have already enrolled with Delta Dental in a previous year, there's no need to re-enroll. If you used another dental plan through payroll deduction or had no dental plan, you will need to enroll with Delta Dental in October to become a member effective January 1.

What are the advantages of visiting a Delta Dental PPO dentist?

You can visit any dentist anywhere in the country, regardless of whether the dentist participates in one of our networks. However, your out-of-pocket expenses may be lower when you use a Delta Dental PPO dentist. A Delta Dental PPO dentist accepts the PPO maximum plan allowance as payment-in-full for covered charges. You are only responsible for non-covered charges, coinsurance and deductibles.

What if I visit a Delta Dental Premier dentist?

Through your Delta Dental benefits, you also have access to the Delta Dental Premier network. This network is the largest network of dentists in Missouri and the nation. If you visit a Delta Dental Premier dentist, you still receive the advantages of negotiated fees (the Delta Dental Premier fee schedule), great service and your dentist will file your claim for you. However, your out-of-pocket expenses may be higher than what they would have been if you had received dental care from a Delta Dental PPO dentist.

Can I visit a dentist who does not participate in a Delta Dental network?

You may choose to visit a non-participating dentist (a dentist who does not participate in one of our Delta Dental networks). If you do, you will not have the advantage of negotiated fees and could be billed for the difference between the dentist's billed (retail) charge and what Delta Dental pays for a covered service. Also, the dentist may request full payment prior to service. You may also have to file your own claim. Claim forms are available on Benefit24 Online after you enroll.

What are Healthy Smiles, Healthy Lives (HSHL) Benefits?

Healthy Smiles, Healthy Lives Benefits (HSHL) provide enhanced coverage options that reflect the current science of oral health care. HSHL benefits provide up to four dental and/or periodontal cleanings per benefit year for persons with certain medical conditions who can benefit from additional cleanings.

Persons with the following medical conditions qualify for additional cleanings with HSHL benefits: pregnant women, persons with diabetes, persons with a history of periodontal disease, persons with kidney failure or who are undergoing dialysis and those with a suppressed immune system, that may be the result of several conditions, including chemotherapy or radiation treatment for cancer, having a stem cell, bone marrow or organ transplant, and persons with HIV.

In addition to the basic HSHL benefits, State employees also have the following benefits:

  1. Full coverage for sealants on first and second permanent molars for children and adults.
  2. Full coverage for brush biopsy, a simple procedure that is an early diagnostic test for oral cancer. Your dentist will only elect this procedure when he or she identifies a spot or lesion he or she determines can benefit from this test.
  3. An alternate benefit allowance for implants. Delta Dental will provide coverage for an implant based upon the cost of a bridge or partial denture, subject to your annual maximum.

If you are a new member effective January 1, after that date, you will need to file a Self-Report Form (see next question) if you have a medical condition that qualities you for additional cleanings. If you are already a member, you can file at any time.

One exception - if you have already been treated for periodontal disease and have a claim for that treatment on file with Delta Dental, you will not need to file a Self-Report Form. Your claim will automatically update your record.

How Do I File a Self-Report Form for extra cleanings?

Once enrolled, you can file your confidential Self-Report Form after January 1. This will only take a few minutes to file online. You also have the option of downloading the form and mailing or faxing it to Delta Dental. Your dentist can also file a confidential Self-Report Form for you. When you file, you have five categories from which to select:

  • Pregnancy - Please provide your estimated due date - ____/____/_____
  • Diabetes
  • Diagnosed with periodontal disease
  • Experiencing kidney failure or undergoing dialysis
  • Suppressed immune system
    (Caused by radiation treatment; chemotherapy; HIV infection; or stem cell, bone marrow or organ transplant.)

Note: If you have already received periodontal therapy and the claim(s) are on file with Delta Dental, you do not need to file a Self-Report Form. Your benefits have already been updated to provide coverage for the additional cleanings/periodontal maintenance visits.

Are extra cleanings available to everyone enrolled?

No. Extra cleanings, up to four dental and/or periodontal cleanings, are available to those with a medical condition that qualifies them for extra cleanings and who have filed a confidential Self-Report Form online, after their membership became effective.

How do you know the individual actually has the condition they indicate?

There is no real incentive for an individual to falsify information using the self-report feature of HSHL benefits. The slight risk of an individual falsifying a health condition to gain additional HSHL coverage is far outweighed by the advantages it offers. Also, we trust your dentist will recommend the correct frequency for cleanings when you share your overall health needs. To further ensure the integrity of the program, Delta Dental will randomly audit HSHL oral health history information on file with members' attending dentists.

How do you know when my pregnancy term is completed?

When you file your Self-Report Form and indicate that pregnancy is the condition that qualifies you for extra cleanings, we also ask you to report your estimated due date. Our system will automatically end the eligibility for HSHL benefits on that date, unless you re-file with a new due date. Claims submitted later with dates of service that fall during the reported pregnancy period will continue to be processed and paid.

Once I am finished with my radiation and/or chemotherapy treatments for cancer, am I still eligible for extra cleanings?

Yes. Sometimes, not always, treatment for cancer can affect saliva production and increase the risk for periodontal disease. To help ensure your good health, we'll let your dentist determine the frequency of cleanings after cancer treatment - up to four cleanings each benefit year. Once you have submitted your Self-Report Form, you will continue to be eligible for extra cleanings, subject to your dentist's recommendations. No need to notify us when your treatments are completed.

How long before or after organ, stem cell or bone marrow transplant am I eligible for extra cleanings?

After your transplant, you become eligible for extra cleanings, and you will continue to be eligible for extra cleanings, subject to your dentist's recommendations. No need to notify us when your transplant is completed.

If I have kidney failure or am on dialysis, when should I report my condition to you to be eligible for extra cleanings?

Any time after the time you are diagnosed, or begin dialysis is fine. After that, your dentist can determine how frequently you should receive cleanings and your MCHCP Delta Dental plan will fully cover up to four dental and/or periodontal cleanings each year.

Are sealants applied to first and second permanent molars good for children and adults?

Yes. Delta Dental maintains a long-term warehouse of claims from its 54 million members around the country. Research on these claims and outcomes suggests that both children and adults who receive sealants experience up to an 80 percent reduction in the incidence of cavities over the five-year period in which the study was conducted. It appears that not only the molars benefit, and that the overall incidence of cavities is reduced as well.

I heard in the news recently that sealants are unsafe. Is this true?

Sealants are one of dentistry's most powerful tools to prevent tooth decay and you can be assured that their benefits far outweigh any potential risk associated with their use. From time to time news articles have called to question the safety of dental sealants due to the potential release of a chemical compound called bisphenol A (BPA). BPA has been shown in laboratory and animal studies to weakly mimic naturally occurring estrogen. But, there is no scientific evidence to show that dental sealants are associated with human estrogenic effects or any other adverse health effect. The potential for exposure to BPA from sealants is very rare, and, when present, occurs for only a few hours at levels well below those known to have biological effects. If you have any questions or concerns regarding sealants or any dental material please discuss these with your dentists.

When should I select an implant?

Your dentist is the best person to determine your treatment for missing permanent teeth. In recent years, implants have become more popular, and their technology has improved. Although the cost to install an implant may be slightly higher than alternative treatments (e.g. bridge or partial denture), long-term evidence suggests that there may be less disruption and subsequent costs of restoration to adjoining teeth (on which a bridge would be anchored). Again, your dentist can review with you the pros and cons of alternate approaches to treatment. Also, you can contact Delta Dental for a "pre-determination" of costs. We'll be happy to inform you of the total costs and the out-of-pocket costs for you of any significant treatment (over $200) that you are considering.

What is a brush biopsy?

It is a simple diagnostic test used for the early detection of pre-cancer or early oral cancer. In about 1 in 10 patients seen, the dentist may see a small red or white spot or small sore and will elect to use a small brush to gather cells from the lip, tongue, or oral mucosa and send the sample to a special laboratory for computer-assisted analysis. Most of the time these spots are harmless; sometimes they are not. The procedure is quick and relatively painless.

A brush biopsy is intended to test everyday harmless-looking spots to help rule out the chance they might be something more. It is not intended to test the infrequent, clearly suspicious oral lesion that general dentists refer to oral surgeons.

What is the value of early oral cancer detection with a brush biopsy?

The most important advances in fighting cancer have come from advances in early detection. For example, the examination of skin moles for melanoma, the Pap smear for cervical cancer, the rectal exam for colon cancer, the PSA test for prostate cancer and the physical exam and mammography for breast cancer. Careful, periodic examination by the dentist and testing of oral lesions can have a similar positive impact for oral cancer.

What portion of the costs of brush biopsy does Delta Dental cover?

Delta Dental fully covers the dentist's fee, up to the maximum plan allowance for CDT code 7288, to perform the brush biopsy and collect the tissue sample. The level of coverage is determined by the group's plan design (100 percent for state employees) and will often be the same as other oral surgery procedures, such as a scalpel biopsy. Generally, the lab fee is covered by the patient's medical plan. However, the patient is encouraged to contact the medical carrier for confirmation of coverage.

When should a brush biopsy be used?

Pre-cancers and early cancers have no distinctive clinical features and often appear to be benign, harmless looking lesions. Clinical inspection at this stage cannot identify which lesions may pose a potential problem. The brush biopsy was developed precisely to evaluate these benign-appearing oral lesions.

The dentist will carefully examine all areas of a patient's mouth. In about 10 percent of patients, the dentist may notice a flat, painless white or red spot or a small sore. Although most are harmless, some are not, and only a brush biopsy will determine the difference.

In some cases, the dentist may elect to use a scalpel biopsy to test for oral cancer if the spot is very suspicious or if the dentist is more familiar with that procedure. If the patient has a sore with a likely cause, the dentist may treat it and ask them to return for re-examination at a later time.

How important is it to diagnose oral cancer in its early stages?

It can be a matter of life and death. This year, more than 8,000 people will die from oral cancer, and 36,000 will be diagnosed. The survival rate for oral cancer is 50 percent, but when found early, it dramatically increases to 80 to 90 percent.
Source: www.oralcancerfoundation.org

Who is at risk for oral cancer?

People who smoke, use chewing tobacco, or drink alcohol are at the highest risk. However, 25 percent of those diagnosed have no apparent risk factors at all. Oral cancer is also on the rise for non-smokers, women and people under age 40.

Is there more information available on brush biopsy?

A summary of information on brush biopsy is available in a downloadable brochure. More information is also available from the manufacturer of the brush biopsy test kit, OralCDx. If you wish, refer your dentist to the OralCDx web site. He or she may also elect to refer you to a specialist for further testing.

What will my out-of-pocket costs be for HSHL benefits?

For extra dental and/or periodontal cleanings with a qualifying health condition, brush biopsy and sealants on first and second permanent molars for children and adults, Delta Dental will pay 100 percent of our maximum plan allowance for these treatments, with no out-of-pocket costs for members.

For the alternate benefit allowance for implants, Delta Dental will pay 50 percent of the cost, based upon the cost of a bridge or partial denture, subject to your annual maximum. That means you will be responsible for 50 percent of the cost, plus any difference between the cost of an implant and the cost of a bridge or partial denture, when the cost of the implant is greater than the cost that a bridge or partial denture would have been.

What is the MAXAdvantage Benefit Option?

All enrolled members have the MAXAdvantage Benefit Option as part of your plan, which means that most routine, preventive care no longer counts against your plan year maximum benefit amount. With MAXAdvantage, you can stretch your benefits. For example, if you have already completed other major work during the year and used your annual maximum, you can still receive your routine exam and cleaning, covered as usual.

If I have more questions about any aspect of my MCHCP Delta Dental plan benefits, who should I call?

You have many options to get your questions answered. For online information, review this site or the MCHCP web site, www.mchcp.org. You can also email your questions to StateOfMOService@ddpmo.org and we will respond within 24 hours. For personal assistance, call Delta Dental at 866-737-9802. Press "2" if you are a current member, and press "5" if you are a prospective member. You can also call MCHCP Customer Service at 800-487-0771.