ALERT! Dentists and other dental providers are not included in the UMP provider network, even if they are listed in the Regence provider directory. The plan pays 80% of the allowed amount, and the provider may balance bill you.
Most dental services are not covered. For example, dental implants, orthodontic services, and treatment for damage to teeth or gums caused by biting, chewing, grinding, or any combination of these is not covered. However, your PEBB dental plan may cover these services. Note: Uniform Medical Plan is not affiliated with the Uniform Dental Plan (UDP). If you are enrolled in UDP, please contact UDP for information.
Under certain circumstances, the plan may cover fluoride supplements
. The application of fluoride varnish may be covered for infants and children starting at the age of primary tooth eruption in primary care practices, for prevention of dental caries (tooth decay); coverage depends on the network status of the provider
. Note that health care providers other than dentists may apply fluoride varnish.
For dental services that are covered by the plan, you pay 20% of the allowed amount and the provider may balance bill you. Only the following dental services are covered:
General Anesthesia During a Dental Procedure
General anesthesia performed during a dental procedure is covered only when:
- It is provided by an anesthesiologist in a hospital or ambulatory surgery center.
- The charges for the hospital or ambulatory surgery center are covered by the plan (see "Dental Procedures Performed in a Hospital or Ambulatory Surgery Center" below).
Dental Procedures Performed in a Hospital or Ambulatory Surgery Center
Dental procedures performed in a hospital or ambulatory surgery center are covered only when the enrollee:
- Is under age 7 with a dental condition that cannot be safely and effectively treated in a dental office; or
- Has a dental condition that cannot be safely and effectively treated in a dental office because of a physical or developmental disability; or
- Has a medical condition that would put the enrollee at undue risk if the procedure were performed in a dental office.
To receive coverage for repair of an accidental injury to natural teeth, the injury must be evaluated and a treatment plan developed and finalized within 30 days of the injury.
The actual treatment may extend beyond 30 days if your provider determines treatment should start later or continue longer. Treatment must be completed by the end of the calendar year following the accident, and you must be currently enrolled in UMP during the entire course of treatment. The plan does not cover treatment after UMP coverage ends.
You have an accident on March 12, 2016, resulting in injuries that are covered by the plan. Your treatment plan must be finalized no later than April 11, 2016. All related treatment must be completed no later than December 31, 2017 (the calendar year following the accident).
The plan does not cover treatment that:
- Was not included in the treatment plan developed within the first 30 days following the accident.
- Extends past the end of the calendar year following the accident or your enrollment in UMP.
UMP Plus Ancillary Provider Type: You may use a network provider affiliated with your UMP Plus network* or a Regence network provider and receive network-level benefits (see
Only the following oral surgery procedures are covered, whether performed by a dentist or a medical professional:
- Excision of tumors or cysts of the jaw, cheeks, lips, tongue, gums, roof and floor of the mouth, or restorative surgery required by the excision.
- Incision of salivary glands or ducts.
- Obturator maintenance for cleft palate.
- Gum reduction for gingival hyperplasia due to Dilantin or phenytoin use.
- Services related to cancer and treatment of cancer, including but not limited to jaw reconstruction.
- Treatment of a fracture or dislocation of the jaw or facial bones.
- Treatment related to chronic conditions that result in loss or damage of teeth.
*UMP Plus Networks: Puget Sound High Value Network (PSHVN) or UW Medicine Accountable Care Network (UW Medicine ACN)