Insurance options for BMC, Evans Medical Foundation, Huntington Theatre, and 660 Corporation employees
Insurance option 1: Dental Maintenance Organization (DMO)Under this option, plan members receive care from one of the Boston University Dental Health Centers (930 Commonwealth Avenue or 100 East Newton Street). This option provides reimbursement of dental care through a highly cost-effective benefits program based on a fixed capitation rate. However, this requires that all dental care must be received at one of the Boston University Dental Health Centers. The Dental Health Centers will charge a fee of $30 for appointments that are not cancelled 24 hours in advance. Provisions will be made for out-of-area emergency dental coverage.
Coverage for option 1 (DMO):
- basic services (preventive, diagnostic, restorative, i.e., routine fillings): 100%
- major services: (crowns, bridges, root canals, gum treatment): 60%
- orthodontics: 40%
- no deductible
- $1,700 annual maximum benefit per person per calendar year
- coverage based on Boston University Dental Health Center fees, which are approximately 30% to 40% below area private practice fees
- fee schedule (pdf)
- no claim form
Insurance option 2: Point-of-Service managed care option (POS)
Employees may elect to seek care from either a Boston University Dental Health Center or from any dental office of their choice. Coverage will vary based on where the service is delivered.
If a plan member seeks care from Boston University Dental Centers, the coverage is identical to the Dental Maintenance Organization option described above.
If a plan member seeks care from an outside office, the dentist must fill out a claim form and send it to Boston University for processing; reimbursement will be sent directly to the patient. No payments will be sent directly to the dental office. There is no assignment of benefits.
Download a claim form for care received at an outside office.
Coverage percentage and comparison for option 2 (POS):
| BU Dental Health Center | Outside Dentist* | |
| basic services (preventive, diagnostic, restorative, including cleanings twice a year) | 100% | 80% |
| major services (crowns, bridges, root canals, gum treatment) | 60% | 50% |
| orthodontics | 40% | 0% |
| cosmetic services (e.g., bleaching and veneers) | 60% | 0% |
| *Allowance for care outside the centers is based on the fee schedule established by Boston University Dental Health Center. | ||
Option 2 in brief:
- no deductible
- $1,700 annual maximum benefit per person per calendar year
- no claim forms for services received at BU Dental Health Centers
- Benefits for this option will be paid at a percentage of the BU Dental Health Center's fee schedule. If outside treatment exceeds $300, the dentist must submit a pretreatment estimate for review by plan administrators.
- The plan will reimburse up to 80% of the Boston University Dental Health Centers' standard fee for preventive, diagnostic, and basic services, and up to 50% of the center's standard fee for major services. Note that the centers' standard fees are approximately 40% lower than the average cost of dental services in the Boston area.
- fee schedule (pdf)