Looking for a Dentist Who Works With Meritain Health?
If your employer provides benefits administered by Meritain Health, you may be wondering how your dental benefits work and where you can use them. At Apolonia Smiles, our team can help you review your dental benefit information, verify available coverage, and better understand your estimated costs before treatment. Meritain Health administers employee health benefit plans, including dental benefits for some plans. Because employers can customize their benefit programs, dental coverage and provider networks can vary significantly from one Meritain Health plan to another. That’s why the best way to determine your specific dental benefits is to verify your individual plan.
What Is Meritain Health?
Meritain Health is a third-party administrator (TPA) of employee health benefits and is an independent subsidiary of Aetna® and CVS Health®.
Rather than offering one identical benefit package to every member, Meritain Health works with employers to administer customized benefit plans. Depending on the employer and plan, benefits may include medical, dental, vision, pharmacy, spending accounts, and other health-related benefits.
Because plans are customized, two patients with Meritain Health may have very different dental benefits.
Does Meritain Health Include Dental Insurance?
Some Meritain Health-administered benefit plans include dental coverage, but the details depend on your employer’s specific plan.
Your dental benefits may use an associated provider network, and the services, deductibles, annual maximums, and coverage percentages available to you will depend on your plan documents.
When you contact Apolonia Smiles, provide your current insurance information so our team can help determine how your benefits may apply at our office.
What Dental Services May Be Covered?
Dental benefits vary by Meritain Health plan. Depending on your specific benefits, coverage may be available for services such as:
Preventive Dental Care
Preventive services may include:
- Routine dental examinations
- Professional teeth cleanings
- Dental X-rays
- Fluoride treatments
- Dental sealants
- Other eligible preventive services
Preventive dentistry plays an important role in maintaining healthy teeth and gums and identifying dental problems early.
Basic Dental Services
Depending on your plan, benefits may be available for basic dental procedures such as:
- Tooth-colored fillings
- Certain tooth extractions
- Periodontal treatment
- Root canal therapy
- Other eligible restorative procedures
Major Dental Services
Some plans may also provide benefits toward more extensive dental treatment, including:
- Dental crowns
- Dental bridges
- Full or partial dentures
- Certain oral surgery procedures
- Other major restorative services
Major services often have different benefit percentages, limitations, or requirements than preventive and basic dental services. Your individual plan determines whether a procedure is covered and how much the plan may pay.
How Do I Know Which Dental Network My Meritain Health Plan Uses?
This is an especially important question for patients with Meritain Health.
Meritain Health-administered plans may use different provider networks depending on the employer and benefit design. As a result, you should not assume that every Meritain Health member has the same dental network.
Your insurance card and plan documents may identify the network associated with your benefits.
Our team can also use your insurance information to help verify available benefits and determine how your plan may apply at Apolonia Smiles.
Understanding Your Meritain Health Dental Benefits
Dental insurance terminology can be confusing. Here are several terms you may see when reviewing your benefits.
Annual Maximum
Your annual maximum is generally the maximum amount your dental plan will pay toward eligible dental treatment during a benefit period. Once that maximum is reached, additional treatment may become your financial responsibility until your benefits renew, depending on your plan.
Deductible
A deductible is an amount you may need to pay toward eligible services before your plan begins paying benefits according to its terms. Some categories of treatment may have different deductible rules.
Coinsurance
Dental plans often pay a percentage of an eligible procedure rather than the entire cost. For example, preventive, basic, and major services may each have different coverage percentages. Your exact percentages depend on your specific benefit plan.
Frequency Limitations
Your plan may limit how frequently it provides benefits for certain procedures. These limitations may apply to services such as:
- Dental exams
- Cleanings
- X-rays
- Fluoride treatments
- Periodontal procedures
- Crowns or other restorations
Waiting Periods
Some plans may require a waiting period before certain procedures become eligible for benefits. Whether this applies depends on your specific dental plan.
No Insurance? We’ve Got Options
If you don’t currently have dental insurance, we also offer an in-office membership plan that provides significant savings on preventive and restorative care. This is a great alternative for patients looking for predictable costs and ongoing dental care without traditional insurance limitations. We also offer flexible payment plans through Cherry Payments.
New Patients With Meritain Health
If you’re a new patient at Apolonia Smiles and have benefits administered by Meritain Health, let our team know when scheduling your appointment. Please have your insurance card or benefit information available. We may ask for:
- Member ID
- Group number
- Policyholder or subscriber information
- Policyholder’s date of birth
- Employer information
- Dental network information shown on your card
Providing accurate information helps our team obtain the most relevant benefit details available before your appointment.