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Supplemental Dental Benefits
KelseyCare Advantage plans offer comprehensive dental benefits that are not covered by Original Medicare and are not included in your medical plan. These extra benefits are available to all KelseyCare Advantage members who enroll in our “Optional Supplemental Dental Plan”. The optional supplemental dental plan is administered by FCL Dental. You must enroll separately into the optional supplemental dental plan and there is a separate premium you are required to pay to be enrolled.
Covered Dental Services
The Optional supplemental dental plan is a comprehensive plan that covers dental services beyond the preventive dental benefits that are included in your KelseyCare Advantage plan. Type II and Type III services refer to such services as fillings, extractions, crowns, root canals and dentures. All services must be provided by an FCL Dental provider.
|Monthly Premium Amount||$32.80 (2021)
|Deductible (For Type II and Type III Services)||$25|
|Copayment (Type I - Preventive Services)||$25 per visit|
|Annual Maximum (After the annual maximum is exhausted, any remaining charges are your responsibility)||$3,000|
|Waiting Period for Type III Services||12 Months|
Percentage of Covered Dental Expenses Payable
Once the deductible is met, Type II and III services will be covered at the coinsurance percentage rates below and paid by FCL Dental up to the Annual Maximum:
|Service Type||Service Description||Coverage Rate||Amount You Pay|
|Type II||Basic Services||80%||20% of the cost|
|Type III||Major Services||50%||50% of the cost|
*Preventive services are not covered in the optional supplemental dental plan as they are included in your KelseyCare Advantage medical plan.
Search for an In-Network Dentist
Once you are enrolled, you can access services from your Optional supplemental dental plan. Simply present your KelseyCare Advantage plan ID card to the FCL Dental provider you have selected.
Need an ID Card?
If you’re a KelseyCare Advantage plan member and are currently enrolled in supplemental dental coverage, you can print instructions on how to access care here.
Alternatively, you can show the dental office your KelseyCare Advantage Medical ID and they can contact our Member Services department to confirm your benefits.