Dental Exam/Cleaning Reimbursement

Did you know that your mouth can be a key indicator of your overall health? 
This is why Mountain Health CO-OP has added an adult dental exam reimbursement to
 your 2021 medical plan and we have worked to keep it
as simple as possible. 


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

    • Helpful hint: The receipt should include one of the following standard Dental Exam/Cleaning codes: D0120, D0140, D0145, D0150, D1110,D1120, D1203, D1204, D1206, D1208, D4910


  • 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 (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