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City of Apache Junction Dental Benefits

Information on City of Apache Junction dental plans, provider links and helpful forms.

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Who is my dental provider?

Although AzMT does contract with Delta Dental of Arizona for their dental provider network (which can be confusing), your benefits provider is AzMT.

What is a deductible?

A deductible is the amount of dental expenses you are responsible for paying before your insurance starts covering you. A common deductible is $50 per person — this means you would be responsible for paying the first $50 in dental treatment expenses before receiving dental coverage.  (Please note under the AzMT dental plan, preventive care, which includes routine oral examination and cleanings, is payable at 100% and does not require satisfaction of the deductible.)

What is coinsurance?

Coinsurance is the cost of a dental service that you are responsible for paying after satisfaction of the annual deductible. Coinsurance is expressed as a percentage. For example, many dental insurance plans have 20% coinsurance for restorative care and extractions and a 50% coinsurance for major services such as crowns, bridges, dentures and orthodontics.

What's an out-of-pocket expense?

An out-of-pocket expense is any cost you have to pay yourself when receiving dental care. This includes your deductible and coinsurance

How many times a year can I have my teeth cleaned?

The AzMT dental plan allows for two (2) cleanings per benefit year (Jul 01 – Jun 30).

Does the dental plan cover orthodontics (braces)?

Orthodontia benefits are provided for adults and children.  Benefits are subject to 50% coinsurance up to a maximum payable per lifetime of $2,000.

Is there a limit on how much the plan will pay for dental services?

Yes.  The plan will pay up to $2,000 per person per calendar year for general dental services and up to $2,000 per lifetime for orthodontic services.

 

What is an Explanation of Benefits (EOB)?

An EOB is a statement which lists the codes of the procedures performed, along with the date of service, amount billed, discount amount (if any), and the amounts payable by the insurance company and the patient.

Is there a network of dental providers that I must use in order to receive dental benefits?

To receive the greatest benefit, you should utilize a Delta Dental of AZ network provider, however, the plan does provide for out-of-network benefits at a lower reimbursement level.

Can I receive benefits for dental care obtained outside of the United States?

You can visit any licensed dentist anywhere in the world for your dental care.  Prior to receiving dental care out-of-country it is recommended that you contact Delta Dental at (800) 352-6132 to request the information needed to process out-of-country dental billings.

What qualifies as a dental emergency?

Dental services that are immediately required to relieve pain, swelling or bleeding, or required to avoid jeopardizing the patient’s health qualifies as a dental emergency.

Who do I contact if I have questions on how or why a dental billing was processed the way it was?

You may contact Delta Dental of Arizona at (800) 352-6132.

What are my options if I do not agree with how a dental invoice was processed or paid by Delta?

The AzMT benefit plans include a benefit appeal process that is included in the Summary Plan Description (SPD) booklets, which are available through your Human Resources Department, and also on this website (see Plan Provisions).

Who do I call to request additional cards?

You can request replacement cards by calling Delta at (800) 352-6132.

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