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Dental
Q1. How many individuals are estimated to be eligible for dental services
under the Benchmark Plan?
A1. It is estimated that in the first year of the program’s implementation,
approximately 5,000 pregnant women and children will be enrolled in the
Benchmark Plan and eligible to receive dental coverage.
Q2. Maximum fees were set at the 50th percentile of the ADA 2005 survey of
dental fees. Why weren’t 2006 fees used?
A2. The ADA survey is only available once every two years. The Benchmark Plan
rates were set using the recently available survey and will be updated as the
ADA ’s survey is updated.
Q3. Under Provider Rights, it was mentioned that under the Standard Plan,
if a patient comes in and does NOT have their co-pay the office CANNOT deny
service. But on the Benchmark plan, if a patient comes in and does NOT have
their cost-sharing, an office CAN deny service. Is this correct?
A3. Under the Standard Plan, providers cannot deny services if a member fails to
make his or her copayment. Under the Benchmark Plan, a provider has the right to
deny services if the member fails to pay any required cost sharing. See
BadgerCare Plus Update 2007-109.
Q4. If a member applies on February 15th and enrollment begins March 1st,
does the $200 deductible/$750 annual benefit limit apply for services that are
provided during the month of February? If so, do the amounts reset on March 1st?
A4. No, the deductible does not apply for services provided during February. The
deductible starts when the enrollment year starts, which in this case is March
1st. See BadgerCare Plus Update 2007-100 titled “Enrollment Verification for
BadgerCare Plus Members” for specific information on the Enrollment Year.
Q5. Where can I found information on a Benchmark Plan member’s payments
counting towards the deductible or the $750 annual limit on benefits.
A5. Providers should contact Provider Services at (800) 947-9627 or (608)
221-9883 for information about a member’s service limitations, cost-sharing
requirements, and enrollment year information. Providers should refer members to
Member Services at (800) 362-3002 for information on a member’s service
limitations, cost-sharing requirements, and enrollment year information.
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