Dental Plans
I have a DMO plan and my Orthodontist is charging me an office visit co-pay, is that okay?
No. Office visit copayments are a set amount, usually $2, $5 or $10, that must be paid by the member regardless of the types of services being performed, with the exception of services from an Orthodontist.
Using the MM ID provided: What is the Group Number?
729560
Using the TIN Provided: What language do they speak?
English
Using the MM ID provided: Is Daxton a student on the plan?
Hamburger - Member - Special Info - Student/Incapacitated Minor - No
Using the MM ID provided: Is the deductible the same Inn & Out of Network?
No
Inn - $50
OON- $60
I have a PPO Max Plan and my provider is OON. How are benefits going to be paid?
Benefits are based on the PPO negotiated rate in the zip code area of the servicing dentist.
Using the MM ID provided: What is the Original Effective date?
01/01/2019
Using the TIN Provided: What date did they become in-network with NETID 01858 Central and South Indiana?
08/22/2024
Using the MM ID provided: is D6010 covered? What is my responsibility?
D6010 NC. MM will be responsible for the dentist charge.
Using the MM ID provided: How is Diagnostic and Preventative, Basic and Major covered at In-network?
D&P- 100%
Basic- 80%
Major- 50%
I have $500 left on my Dental Fund, but the dentist submitted charge is $900. What is my responsibility?
$400
Using the MM ID provided: My son just turned 24, can I add him to my plan?
Yes, Definition of Dependents state "up to age 26".
Using the TIN Provided: What is the Fee Code under NETID 01860?
6IX
UsingGRP: 812310: I need to terminate my plan. Who do I contact.
Member needs to contact HR. HR Telephone Number: 609-292-7524
Using the MM ID provided: Is the Maximum the same inn and OON?
No:
INN- $1,500
OON- 1,000
What makes the FOC (Freedom of Choice) plan unique?
It allows the member the ability to choose between DMO and one of our Indemnity or PPO plans throughout their benefit year
Using the MM ID provided: Does the Member need to assign a PCD, if so, where can I document it?
Yes, Case Screen, SR to the left
Using the TIN Provided: NETID 01860, what address are they in-network with under this contract?
919 E Jefferson Blvd South Bend, IN 46617
Using the MM ID provided: Can you send me ID cards?
No, Physical id cards are not available to mail to members covered by this plan sponsor.
Using the MM ID provided: How many cleaning can I get?
Prophy Limited to 2 treatments per calendar year
I have a DMO plan and I need a referral for an orthodontist. Who can provide me the referral?
DMO Members do not need a referral for Ortho.
Using the MM ID provided: Is this Plan Fully Insured or Self Insured?
Fully Insured
Using the TIN Provided: When did NETID Contract 10357 terminate?
09/01/2025
Using the MM ID provided: What is the frequency for D4910 Periodontal Maintenance?
PERIODONTAL MAINTENANCE FOLLOWING ACTIVE PERIO THERAPY-2 PER CAL YEAR.
Using the MM ID provided: Is there Orthodontia coverage?