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Provider Manual

Dental services covered as a supplemental benefit

Last Updated on August 28, 2018
  • 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
  • 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.