If you have recently gotten a Manhattan Life Dental policy, you likely came into Medicare and quickly discovered that Medicare does not cover dental. This policy is a pretty good solution for your dental coverage going forward. This guide will walk you through the Manhattan Life policy, its benefits, and how to use it, because it is important to understand it so you can maximize your return. Since this is something you are investing in, you want to be able to get your claims handled when you visit the dentist.
You can always return to this guide at manlifedental.com if you need a refresher in the future, for example when filing a claim after a dental visit six months from now.
Why Manhattan Life Dental?
This policy has been offered for quite a while and has a strong track record. It generates very few complaints or troubles, which means it is working well for the people using it.
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One of the key advantages of this policy is that it is an indemnity policy. This means there is no required network. You can go to any dentist you like, pay for your dental services, submit a claim, and they will reimburse you. It is important to understand the reimbursement amounts and how the process works so you have realistic expectations about what you will get back.
Using the Carrington Network
While you can visit any dentist, Manhattan Life also offers access to the Carrington Network. If your dentist is part of this network, the process may be a little easier and possibly less expensive, since rates have been pre-negotiated. In that case, the dentist would file the claim directly and you would simply pay your portion at the office.
You can ask your dentist if they are part of the Carrington Network. Either approach works well, but knowing your options helps you make the best choice.
Plan Overview and Annual Benefits
When reviewing the plan benefits, here are the key details to know:
- Annual benefit maximum: Options typically range from $1,000 to $3,000, with $1,500 per year being the most common choice. A $2,500 option may also be available.
- Annual deductible: $100. You will pay the first $100 out of pocket before the plan begins to reimburse you. Your first dentist visit will likely fall under this deductible.
- Guaranteed issue and guaranteed renewable: Once you have the plan and continue paying for it, it cannot be taken away.
- Family rates: For those 65 and older, individual policies generally offer better pricing than family rates, even for couples.
Think of your annual benefit as a bucket of money. You can use it all on dental, all on vision, or split it across both. It is simply a reimbursement pool for whichever covered services you use.
Dental Coverage
Dental plans work with waiting periods and graduated benefits. You cannot wait until you have significant dental problems and then expect insurance to cover everything right away. Here is how the coverage builds over time:
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Preventative Services
Includes annual exams, cleanings, and X-rays. There is no waiting period for preventative services.
| Year | Plan Pays | You Pay |
|---|---|---|
| Year 1 | 60% | 40% |
| Year 2 | 70% | 30% |
| Year 3+ | 80% | 20% |
Major Services
Includes bridges, crowns, full dentures, partials, full mouth extractions, and root canals. There is a 12-month waiting period before major services are covered.
| Year | Plan Pays | You Pay |
|---|---|---|
| Year 1 | Not covered | 100% |
| Year 2 | 70% | 30% |
| Year 3+ | 80% | 20% |
Important note: Reimbursements are based on usual and customary rates. If your dentist charges above those rates, you may be responsible for the difference.
Also, dental implants are not covered by this plan. This is standard across virtually all dental insurance plans, as implants are generally not something any insurance plan will pay for.
Vision Coverage
This policy is a combined dental, vision, and hearing plan. The $1,500 annual benefit bucket can be used across all three. Vision coverage is also available as a standalone option if needed.
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Vision coverage includes basic eye exams, refractions, eyeglasses, and contact lenses. Designer frames and upgraded eyewear scenarios are not covered. Coverage is for regular, basic eyewear.
| Year | Plan Pays | You Pay |
|---|---|---|
| Year 1 | 60% | 40% |
| Year 2 | 70% | 30% |
| Year 3+ | 80% | 20% |
Hearing Coverage
Hearing coverage follows the same graduated reimbursement structure as dental and vision.
| Year | Plan Pays | You Pay |
|---|---|---|
| Year 1 | 60% | 40% |
| Year 2 | 70% | 30% |
| Year 3+ | 80% | 20% |
How to File a Claim
To file a claim, visit clients.manhattanlife.com and log in to your account. If you are not yet registered, you can register there as well.
Step 1: Get the Claim Form Filled Out
Ask your dentist or the front desk staff to fill out the dentist portion of the claim form. They will need to provide details such as their license number and EIN number. Also request a detailed receipt from your dentist.
Step 2: Download the Claim Form
Once logged in, navigate to the Forms section of the website. From there, select:
- Dental and Hearing Claim Form for dental or hearing claims.
- Vision Claim Form for vision claims.
Step 3: Upload Your Claim
Once your claim form is filled out and you have your receipt:
- Save the completed claim form as a PDF.
- Save your receipt as a PDF.
- Go to the Easy Upload section on the website.
- Select your policy number, indicate you are uploading a claim, and attach your PDF files.
Turnaround Time
Processing typically takes two to four weeks. Manhattan Life will notify you if they need any additional information. Once processed, you will receive a reimbursement check.
A link for the claim form and the full plan brochure are available at manlifedental.com for easy access whenever you need them.
Frequently Asked Questions (FAQ)
Q: Why do I need a separate dental policy when I have Medicare?
A: Medicare does not cover dental services. A policy like Manhattan Life Dental fills that gap and provides coverage for dental, vision, and hearing.
Q: Can I go to any dentist with this plan?
A: Yes. This is an indemnity policy, meaning there is no required network. You can visit any dentist, pay for services, and submit a claim for reimbursement. You may also choose to use a dentist in the Carrington Network for added convenience.
Q: What is the Carrington Network?
A: The Carrington Network is a network of dentists that participate in this plan. Using a Carrington Network dentist may make the process easier and potentially less expensive due to pre-negotiated rates.
Q: What is the annual deductible?
A: There is a $100 annual deductible. You will pay the first $100 before the plan begins reimbursing you.
Q: Is there a waiting period for preventative dental services?
A: No. Preventative services such as exams, cleanings, and X-rays are covered from the start with no waiting period.
Q: When does coverage for major dental services begin?
A: Major services such as crowns, bridges, root canals, and dentures are not covered in the first year. Coverage begins in year two at 70%, increasing to 80% in year three and beyond.
Q: Does this plan cover dental implants?
A: No. Dental implants are not covered by this plan. This is standard across virtually all dental insurance policies.
Q: How long does it take to receive reimbursement after filing a claim?
A: Reimbursement typically takes two to four weeks after your claim is submitted.
Q: Where do I file a claim?
A: Log in to your account at clients.manhattanlife.com, download the appropriate claim form, have your dentist fill out their portion, and upload the completed form along with your receipt using the Easy Upload feature.
Q: Can I use my annual benefit for vision and hearing as well as dental?
A: Yes. The annual benefit works as a shared pool that can be applied to dental, vision, and hearing services.
Conclusion
The Manhattan Life Dental policy is a flexible and reliable option for dental, vision, and hearing coverage in retirement, especially since Medicare does not cover these services. By understanding how your benefits build over time, knowing how to navigate in-network and out-of-network options, and following the straightforward claims process, you can make the most of your annual benefit and get the reimbursements you are entitled to.
