Understanding Dental Plans
Frequently Asked Questions
Application Process
Does My Dental Plan offer takeover benefits?
If you were previously covered under a dental plan, you may be eligible for takeover benefits, which means waiting periods are waived. During the application process you will be asked to complete and submit a replacement form and provide information about your prior plan, including the date of termination. You may be required to provide an evidence of coverage letter from your prior carrier. The letter must include a termination date of the prior plan that is no more than 30 days prior to the date we receive your application for coverage.
What happens after I apply for an Individual Plan?
Once you submit a completed application for individual coverage, we begin processing your application. Once your application is approved, you’ll receive a notification e-mail. At that time, we’ll mail you your policy and ID cards. Carefully review your policy and ID cards. Your policy will include your effective date (the date when coverage begins). Billing and Premium Payments
Are my rates guaranteed?
Your rates are guaranteed for 12 months following your plan’s effective date. After that, you will receive at least 30 days’ notice (more if required by state law) if your rates change.
How often can I make premium payments?
When applying for coverage you can choose to make your premium payments monthly, quarterly, semi-annually or annually.
Eligibility, ID Cards, Adding or Cancelling Coverage
Who is eligible to purchase the plan?
The insurance coverage is available in states where it’s approved to anyone age 18 and older. You can request coverage for your dependents.
When will I be covered by my policy?
You will be covered by your policy on your chosen effective date, provided your application has been approved and we’ve received your first premium payment. You can choose an effective date during the application process.
Do I have coverage outside of the state I live in?
Yes, if you are traveling or have a covered dependent living in a different state, you will still have coverage.
What is my ID number?
Your ID number is the policy/division/certificate number located on your ID card. You may also use your Social Security number.
What if I want to cancel the policy?
Once the request is received, the policy will be canceled either the first day of the following month or the requested cancellation date (must be the first of a month).
Choosing a Dental Provider
What is an in-network dental provider?
An in-network dental provider participates on the dental PPO (participating provider organization) network. Plan members can choose from more than 583,000 PPO provider access points nationwide for dental care. Use our online provider directory to find an in-network dental provider.
How do I benefit when I visit an in-network dental provider?
You may benefit from greater out-of-pocket savings when you visit a dental provider on the dental PPO network.
Can I see any dental provider or am I required to choose one from your PPO list?
You are always free to visit any dental provider you choose. However, you may benefit from greater out-of-pocket savings when you visit a dental provider on our PPO network.
How do I know if my dental provider is part of the PPO network ?
Search for your dental provider in the Find a Provider directory on this website.
My dental provider isn’t on your network, but I want to take advantage of network benefits. What should I do?
You can nominate your provider to become part of our network by completing the provider nomination form. Please understand that nominating a provider doesn’t guarantee they will become an active participant in the PPO network.
Common Terms
What is an annual maximum ?
An annual maximum is the maximum dollar amount a dental plan will pay toward the cost of dental care incurred by an individual or family in a calendar year.
What is a waiting (elimination) period ?
A waiting period is a period of time a person must be enrolled in a plan before qualifying for benefits.
Understanding Dental Plans and Dental Insurance
What are the different kinds of dental plans ?
Dental plans can be either employer-based on self-purchased. Group dental insurance is always cheaper as the premium is subsidized; due to employer or bulk membership discount.
How do Dental PPO Plans work ?
Dental PPO Plans or Preferred Provider Organization plans are most often a real balance between dentist of choice and keeping costs low. Your PPO dentist agrees to a contracted fee. In this scheme, you pay a certain percentage of the rate and your dental plan pays the rest. Additional charge is levied on you if you choose a dentist who is not listed.
How do Fee-for-service plans work ?
Traditional dental plans or Fee-for-service plans or indemnity plans work much like the PPO scheme but the deductible you pay might be a bit higher. The insurance company pays claims to dentists based on dental procedures performed.
How do Discount Dental Plans work ?
Discount plans are not really dental insurance plans but you get the benefit of discounted rates from participating dentists. You pay an annual or monthly charges. Obviously, the cost of dental work is largely borne by you. Sometimes, you pay the entire amount directly to the dentist of your choice. Then you are reimbursed a percentage based on your plan. You need to submit proof of treatment.
How do Dental HMOs work ?
Dental HMOs work much like medical health centers. You choose a primary care dentist and get your routine oral care done there. For any other treatment, you will be referred to a specialist.
Online dental plan enrollment can be done. Read the online information to check waiting periods, additional benefits and out-of-network claims. See if your preferred dentist is part of the network. Some low-cost dental plans allow you to fix appointments only in off-peak times. Don’t look at the price alone for making a choice. If you are a younger person with healthy teeth and gums, you can look more at preventive coverage. You can select a preventive dental plan with checkups, cleaning and x-rays. If you are older or suffer oral issues, look for insurance accordingly to include root canals, dentures and crowns.
