City of Austin FLEXTRA Accounts FAQ

Q. What dental provider can I use with this plan?

A. The COA Dental Assistance Plan is not a PPO or DMO plan and does not have any "in network" or "preferred" providers. You may receive dental services from the dentist of your choice. Providers do not have to be located in the Austin area.

Q. What is my maximum benefit?

A. The maximum amount of benefits payable for each person covered by the plan is $2,000 per calendar year.

Q. What is my deductible?

A. Each Covered Person is required to meet a $50 deductible each calendar year before the plan pays benefits for basic, major, and orthodontia care.

Q. What is the plan year?

A. The plan year is a period of 12 consecutive months, beginning January 1 and ending December 31.

Q. Do I have a co-pay for dental benefits?

A. The COA Dental Assistance Plan does not have set co-pay for any dental services. The patient is responsible for the difference between the amount billed by your provider and the amount paid by the dental plan. The maximum allowable amount is provided on the Table of Allowances for each covered service.

Q. How can I get a new/replacement dental ID card?

A. Contact CompuSys/Erisa Group, Inc. to request another ID card. Dental ID cards are mailed weekly.

Q. What is the "fee schedule" and where can I get one?

A. The Table of Allowances (fee schedule) is provided in the Employee Dental Assistance Plan Document. If you do not have your plan document, a copy is available from the Employee Benefits Division or downloadable in the Quick Links section of this website.

Q. How long will it take to process my claim?

A. Dental claims are processed within 7-10 days of receipt of a complete claim.

Q. My dental provider does not accept insurance or will not file claims for me. How do I get reimbursed?

A. You may request reimbursement for your dental services by completing the City of Austin Dental claim form, available on the Quick Links section of this website, and mailing to CompuSys/Erisa Group with an itemized statement of charges from the dental provider.

Q. I thought I receive two free cleanings per year?

A. Each covered dental service is paid according to COA Table of Allowances. Although preventive services, such as teeth cleaning, oral exams and x-rays, are not subject to the $50 deductible, the patient is responsible for the difference between the amount billed by your dental provider and the amount paid by the dental plan.

Q. I have met my $2,000 maximum. When will I have more benefits available?

A. The $2,000 annual maximum benefit is based on a calendar year. Benefits will be available the following year for services incurred on January 1st and after.

Q. Why wasn't the fluoride treatment covered?

A. Fluoride treatment is covered once per calendar year for dependent children under age 13. Fluoride treatment is not covered for covered members over age 12.

Q. Is anesthesia or nitrous oxide covered?

A. Anesthesia, nitrous oxide, and sedation are covered by the plan if listed on the Table of Allowances and will be reimbursed up to the maximum allowable amount for each service, subject to the annual deductible.

Q. I received an Explanation of Benefits (EOB) in the mail, who do I pay the "patient responsibility" portion to?

A. The EOB statement is provided when each claim is processed to detail the total amount billed by the dental office, the amount paid by the plan, and patient responsibility. The patient responsibility is owed to your dental provider if payment was not made at the time of service.

Q. How does the plan coordinate benefits with my primary insurance carrier?

A. If a person is covered under another plan, the benefits payable under this plan will be reduced by the benefits payable under all other plans so that the total payment under this plan and all other plans does not exceed the maximum allowable charges listed on the fee schedule.

Q. We are covered by two insurance plans, which plan is primary and which is secondary?

A. There are a series of rules set forth in the Summary Plan Description (SPD) for determining which plan covers the patient as primary. Refer to Section 6.2 Order of Benefits. The SPD is located in the Quick Links section of this website.

Q. My crown needs to be replaced. Is this covered by the dental plan?

A. The dental plan covers replacement of prosthetics (crown, bridge, denture, etc.) that were initially placed more than five years prior to the replacement crown.

Q. What is not covered under the plan?

A. The following services are not covered by the Dental Assistance Plan:

  • Expenses in excess of the calendar year or orthodontia lifetime maximum
  • Services performed for cosmetic reasons
  • Replacement of missing, lost, or stolen appliances
  • Implants and related services, except implant supported prosthetics
  • Night guards, mouth guards, or other occlusal guards
  • Orthodontia care if initial treatment or banding began prior to the effective date of coverage under the plan.