Here’s how it works….

 

• You pick your provider

  • Helpful hint: Please check with your provider regarding the cost of the exam ahead of time to make the most of the $100 reimbursement

• Go to your appointment and pay direct – make sure you get a copy of your receipt

  • Exam/Cleaning/Fluoride codes: D0120, D0140, D0145, D0150, D1110,D1120, D1203, D1204, D1206, D1208, D4910 If codes are not available please make sure services are listed.

 

• Submit your receipt along with the claim form, to Mountain Health CO-OP. For your convenience, we provide three ways for you to submit:

 

• Email to memberservice@mhc.coop (preferred);

• Fax to 801-281-6121 Attn: Member Reimbursement; or

• Mail to University of Utah Health Plans, PO Box 45180, Salt Lake City, UT 84145-0180

 

• The CO-OP will reimburse you and your dependents listed on the policy up to $100 each for the dental exam/cleaning, excluding x-rays – reimbursement will be mailed to you within 15 business days of receipt​