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Product Overview HMO and D-SNP
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Utilization Management
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Benefit Information
Dental services covered as a supplemental benefit
Last Updated on January 24, 2019
- Medicare Advantage Core, Southern and Eastern members have a supplemental preventive dental benefit.
- Ally Rx D-SNP and Secure Saver MSA members do not have coverage for supplemental preventive dental services.
- To qualify for coverage, services must be performed with a provider who is contracted with Liberty Dental.
- Liberty Dental Provider Network can be found here
- Select “Security Health Plan” from the benefit plan dropdown
- Liberty Dental Provider Network can be found here
- Services covered under the supplemental preventive dental benefit include one cleaning, one preventive exam and a full mouth X-ray,
panoramic X-ray or up to four bitewing X-rays per calendar year.- These services are covered at 100% by Security Health Plan.
- Additional services or services over the benefit maximum are not covered.
- Claims should be submitted directly to Liberty Dental on dental claim forms.
- Questions about benefits, limitations, covered services, provider network, or claims should be directed to Liberty Dental Customer Service at 1-877-550-4437.
Dental services covered under the medical benefit
- Security Health Plan Medicare Advantage plans, including Ally Rx D-SNP and Secure Saver MSA, follow Medicare guidelines on coverage for dental services covered under the medical benefit.
- For information on dental services that Medicare covers see the CMS.gov website.
- Medicare covered dental services must be completed by a Medicare certified provider to qualify for coverage.
- Claims for dental services covered under the medical benefit must be submitted on a CMS 1500 claim form. Claims submitted on a dental claim form will be denied.