ASO - Management Benefits Fund Dental Plan Enhancements - January 1, 2023
ASO - Management Benefits Fund Dental Plan Enhancements - January 1, 2023
With ASO, you will have access to their network as well as the Careington Network, a national network with more than 250,000 locations. Close to 90% of members see dentists in these networks. When you go to your dentist, tell them you have dental coverage with MBF through ASO and the Careington network. The dentist search tool will help you locate network dentists, view information about the office and review your expected out-of-pocket expenses.
ASO will begin processing claims for services incurred starting January 1, 2023.
Reminder: All claims with service dates prior to January 1, 2023 are subject to the current plan benefits and must be submitted to Healthplex. In order to expedite processing of your claims, we encourage you and/or your provider to submit any outstanding dental claims that are not yet submitted to Healthplex. New Dental Claim Form
| Plan Design | 2022 Current Benefits | 2023 Enhanced Benefits |
|---|---|---|
| Service Dates | Services Rendered prior to 1/1/2023 | Services Rendered on or after 1/1/2023 |
| Annual Maximum (Individual) | $4,000 | $5,000 |
| LT Orthodontic Maximum | $4,000 (medical requirement for adult orthodontic treatment) | $6,000 (eliminates adult medical document requirement) |
| Basic Restorative (extractions, fillings, root canals and periodontal treatment) (Out-of-Network) | 70% | 80% |
| Major Restorative (crowns, dentures and bridges) (Out-of-network) | 70% | 80% |
| Dental Implants (In-network and Out-of-network) | 50% | 80% |
| Extractions, Fillings, Inlays, Onlays, & Crown Limitation | Limitation of 5 Years | Limitation of 3 Years |
| Full/Partial Denture Replacement | Limitation of 5 Years | Limitation of 3 Years |
| Fixed Bridge Replacement | Limitation of 5 Years | Limitation of 3 Years |
Continuation of coverage is subject to all terms and conditions outlined in the MANAGEMENT BENEFITS FUND SUMMARY PLAN DESCRIPTION and may end in certain circumstances, including, but not limited to pay premiums, fraud, or the individual no longer meets the eligibility requirements for Young Adult Dependent Coverage.
To be eligible for MBF Direct Pay Coverage Continuation (“DPCC”), the Young Adult Dependent(YAD) does not have to live with an MBF Member, be financially dependent on an MBF Member, or be a student. However, the Young Adult Dependent must meet the following requirements:Be unmarried, Be 29 years of age or younger, not be covered by Medicare, live, work or reside in New York State, or the health insurance, dental or vision care program service area.
The MBF member must be active in MBF in order for his/her Young Adult Dependent to be eligible for DPCC. For more information regarding MBF YOUNG ADULT DEPENDENT COVERAGE, please visit MBF website at NYC.gov/mbf.
