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Dental Plan FAQ's

Prepaid plan dentists

  1. How do I select a Prepaid Plan Dentist?
  2. Must all family members select the same Plan Dentist?
  3. How will the Plan Dentist know I am a patient?
  4. How do I make an appointment?
  5. What do I do if I need to cancel my appointment?
  6. How much and when do I have to pay for my dental visit?
  7. Can I change my Plan Dentist?
  8. What if I choose to see a dentist other than my selected Plan Dentist?
  9. If I have a dental emergency, do I need to see my Plan Dentist?
  10. If I need to see a specialist, how do I go about finding a Plan Specialist in my area?
  11. How do I know if a specialist accepts the Specialty Benefit Amendment (SBA)?

How do I select a Prepaid Plan Dentist?

You will need to select your Plan Dentist at time of enrollment or shortly thereafter to access benefits. To search for participating general dentists go to Find a Dentist. Be sure to select the correct plan when you begin your search. If you are not sure which plan you are on please check your Dental ID card or call 800.443.2995. You may also refer to your plan network directory for a listing of Plan Dentists. Note that your Plan Dentist must be a general dentist, not a specialist.

Must all family members select the same Plan Dentist?

Each eligible family member may choose a different Plan Dentist, unless you live in Michigan or New Jersey . In Michigan and New Jersey , the entire family must be assigned to the same Plan Dentist. In all other states, it is important that every eligible family member select a Plan Dentist.

How will the Plan Dentist know I am a patient?

The Plan Dentist receives a patient listing, called a roster, from us each month that includes all members who have chosen that provider as their dentist. Please confirm with the Plan Dentist at the time you make your appointment that you are on their roster.

During the enrollment process, if we receive your Plan Dentist selection by the 10th of the month, you will appear on the roster the 1st of the next month. If we receive your selection after the 10th, you will appear on the roster the 1st day of the second following month. If you are not listed on the roster, please call us at 800.443.2995.

How do I make an appointment?

After you have selected a Plan Dentist, call the dental office, identify yourself as a prepaid member, and schedule an appointment. If you have not selected a Plan Dentist, contact Customer Service at 800.443.2995 prior to scheduling an appointment. Remember that your appointment date must be after your coverage becomes effective and on or after your Plan Dentist assignment date.

What do I do if I need to cancel my appointment?

Simply call your Plan Dentist to cancel your appointment. Please give the dental office at least 24 hours notice or you may be charged a missed appointment fee per your Copayment Schedule.

How much and when do I have to pay for my dental visit?

You will be charged according to your Copayment Schedule located in your Evidence of Coverage. Please discuss all treatments and the related charges with your Plan Dentist before the services are performed. Payment for all dental services are due at the time treatment is rendered. Dental services not listed on your Copayment Schedule are not covered, so your Plan Dentist will charge you his or her normal fee.

Can I change my Plan Dentist?

Yes, you can. To change your Plan Dentist, contact Customer Service at 800.443.2995. If you change your Plan Dentist by the 20 th of the month, you will appear on your new Plan Dentist's roster the 1st of the next month. If you change your Plan Dentist after the 20th of the month, you will appear on the new Plan Dentist's roster the 1st day of the second following month.

What if I choose to see a dentist other than my selected Plan Dentist?

The costs will not be covered by your dental plan and you will be responsible for the full payment to the dentist. This is why it is important for you to seek treatment from your selected Plan Dentist.

If I have a dental emergency, do I need to see my Plan Dentist?

First, contact your Plan Dentist to make an appointment. If your Plan Dentist is unable to see you, you may seek treatment from any licensed dentist in the United States . Please be informed that the emergency benefit in your plan is limited to the temporary relief of pain and has limited benefits.

If I need to see a specialist, how do I go about finding a Plan Specialist in my area?

You should refer to your Plan to determine if you must obtain a referral from your Plan Dentist prior to seeking treatment from a Plan Specialist. If your Plan does not require you to obtain a referral from your Plan Dentist, then you may search online for a participating Plan Specialist. You may also find a list of Plan Specialists by looking in the plan network directory or by calling 800.443.2995 for assistance.

How do I know if a specialist accepts the Specialty Benefit Amendment (SBA)?

In the plan network directory and on the web site under Find a dentist there will be an indicator by the specialist to identify if they accept the SBA.