Student Health Plans

Follow Health Care for Students to access information about the UMB Counseling Center, CareFirst Blue Cross Blue Shield and an optional dental plan.  Follow the Student Health link for location, hours, services provided and specific information about Birth Control Pills, Immunizations and the Needle Stick Procedures.

Student Dental Plan

DENTAL BENEFITS

If a person, while covered under this provision, incurs an expense, the AEGD Clinic, located at the Dental School on campus, will pay a percentage of that expense after the Elimination Period, if any. The AEGD Clinic will pay up to the maximum for each covered person. The AEGD Clinic will pay only for an expense incurred after the end of any Elimination Period, if any. The Percentage Payable, Elimination Period, and Maximum for the Classes of Services for which the person is covered are shown in the Schedule of Benefits.

Covered Services

1. Class I Covered Services:

1. Diagnostic Examination: Limited to one in any one calendar years. Periodic/preventive exams limited to one/year. Emergency exam covered at the Dental School, per episode up to three episodes per year.

2. Preventive Treatment: Limited to two prophylaxes in any one calendar year, but not less than six months apart

3. Fluoride Treatment: Limited to one in any one calendar year for dependent children age 16 and under.

4. X-rays:

• Complete series:

• Intraoral, up to 14 periapicals with up to four bitewings; or

• Panoramic, with up to four bitewings

Limited to one complete series in any five consecutive calendar years.

• Bitewings are limited to four in a calendar year including any bitewings taken as part of a complete series as show in (d) (1) above.

• Periapicals when indicated by changing clinical condition, including positive historical findings or clinical signs/symptoms; but not to exceed the cost of a complete series in any one calendar year.

5. Space Maintainers: For premature tooth loss of primary teeth, to maintain space, for dependent children age 10 and under.

6. Dental Sealants: Limited to dependent children age sixteen and under and then only when applied to the occlusal surfaces of unrestored and non-decayed first and second permanent molars and first and second premolars limited to one treatment per tooth in any four consecutive calendar years.

2. Class II Covered Services:

1. Oral and Maxillofacial Surgery:

• Extractions (erupted teeth or roots)

2. Restorations: Composite restorations posterior to the canines are limited to the amount otherwise payable for an amalgam restoration. Direct and indirect pulp capping will not be a covered service when performed at same time as placement of the definitive restoration. Amalgam foundations and prefabricated posts are included in Class Ii services.

3. Nitrous Oxide: Only when administered in conjunction with a medically necessary dental procedure and then only when administered in a dental office by a person licensed or credentialed to administer the sedation.

4. Palliative treatment for relief of dental pain.

5. Periodontal Procedures:

• In the presence of periodontal disease, periodontal scaling once in any calendar year and an adult prophylaxis (01110) not less than six months later

• In documented cases types II, Ill, and IV periodontal scaling and root planing (04341) once in any calendar year and one periodontal maintenance visit (04910) not less than six months later.

3. Class III Covered Services:

1. All other oral surgery is to be provided at the Dental School, Advanced General Dentistry Clinic. No coverage outside of Advanced General Dentistry Clinic.>

2. All other covered periodontal procedures not included in 2 (e) above.

4. Class IV Covered Services:

1. All endodontic procedures (pulpotomy, root canals and periapical procedures).

2. Initial placement of removable full or partial dentures or fixed bridge when:

• needed to replace one or more natural teeth lost or extracted while covered under this provision; there is no coverage for replacement of teeth missing prior to coverage under this plan. Replacement will be at prevailing full Advanced General Dentistry fees.

• if an interim denture is utilized, any amount payable for the interim denture will be deducted from the amount payable for the final prosthesis. The final prosthesis must be completed within one year of placement of the interim denture. An interim denture that is retained beyond the one year time limit will be subject to the limitations governing the replacement of existing dentures.

3. The replacement or alteration of a removable full or partial denture or fixed bridgework, when necessary by oral surgery, while covered under this plan:

• resulting from an accident;

• for the extraction of a tooth or teeth; or

• because of structural change within the mouth.

Benefits will be payable only if the existing prosthesis is not serviceable and cannot be made serviceable.

4. Replacement of an existing complete or partial denture only if the existing denture is not serviceable, cannot be made serviceable and the existing denture is more than five years old.

5. The addition of teeth to an existing partial denture when the addition is needed to replace teeth extracted while covered under this provision.

6. Adjustments, rebasing or relining of removable partial dentures, but only after at least six months since insertion, provided the denture was covered under this plan

7. Adjustments, rebasing or relining of complete denture, but only after at least twelve months since insertion, provided the denture was covered under this plan.

8. The replacement of fixed bridgework only if the bridgework is not serviceable, cannot be made serviceable and the previous placement was at least eight years ago. Otherwise, replacement at full Advanced General Dentistry fees.

9. Cast restorations and crowns:

• Cast restorations, including cast posticore, and crowns, when standard fillings will not adequately restore teeth damaged by decay or fracture.

• Veneered second molar crowns are limited to the amount otherwise payable for a full metal cast crown.

The replacement of the existing cast restorations and crowns only if a medically necessary dental procedure and the previous placement was more than eight years ago. Otherwise, replacement at full Advanced General Dentistry fees.

10. Repair of crowns, cast restorations, dentures, bridgework or recementation of crowns, cast restorations or bridgework covered under this plan.

 

STUDENT DENTAL PLAN

 

BENEFIT SUMMARY:

PLAN I

Deductible $0.00

Class I Preventive: Plan pays 100% of fee schedule, no deductible, no co-pay.

Class ~ Basis: Plan pays 80% of fee schedule, no deductible, 20% co-pay

Class III Periodontics, Oral Surgery: Plan pays 50% of fee schedule, no deductible; 50% co-pay.

Class IV Endodontics, Fixed Bridgework, Full or Partial Dentures: Plan pays 50% of fee schedule, no deductible, 50% co-pay.

Class V Orthodontics: Not covered - but available at discounts off regular fees.

Annual Maximum: $1,250.00

 

PLAN II

Deductible $0.00

Class I Preventive: Plan pays 100% of fee schedule, no deductible, no co-pay.

Class II Basic: Plan pays 65% of fee schedule, no deductible, 35% co-pay.

Class III Periodontics, Oral Surgery: Plan pays 25% of fee schedule, no deductible, 75% co-pay.

Class IV Endodontics, Fixed Bridgework, Full or Partial Dentures: Plan pays 25% of fee schedule, no deductible, 75% co-pay.

Class V Orthodontics: Not covered - but available at discounts off regular fees.

Annual Maximum: $1,500.00

Students can enroll at the beginning of any month during the semester, rates will not be prorated but you will be eligible for the full six-month benefit. Premiums paid for a semester are non-refundable.