Frequently Asked Questions

When can I start using my policy?

You can start using your policy as soon as your plan effective date. However, some services have a waiting period.

What is an annual maximum?

It is the maximum amount of money the policy will pay out during your policy's year from your plan effective date to the next based on the benefit plan you select.

How do I find an in-network provider?

You can search for a list of providers here.

What is my deductible?

Your deductible is a dollar amount you must pay out-of-pocket for covered dental expenses in a plan year. After your deductible, your policy reimburses expenses based on the benefit plan you choose up to the annual maximum.

What is the "allowed" amount on my dental insurance policy?

The allowed amount is the amount of billed charges after the network dental discount is applied for a covered dental service (if in-network). Your policy will pay a certain percentage of the allowed amount - depending on the policy year and the benefit plan you choose.

Why does it cost less to see an in-network provider than an out-of-network provider?

In-network providers have agreed to offer services at a negotiated discounted rate. If you visit an in-network provider, you "may" pay less out of pocket.

Can I see an out-of-network dentist?

Yes. However, dentists who are not in-network may bill you for their normal fee for procedures billed beyond the maximum payable benefit. Your plan provides benefits using amounts that we have set as the "maximum allowed amount" for each service in your geographic area. When we set the "maximum allowed amount," we may consider other factors, including the prevailing charges in your area. The "maximum allowed amount" does not suggest your dentist's fees are not reasonable and proper.

Your dentist may "balance bill" you for the difference between his or her normal fee and our "maximum allowed amount." This amount is not covered, and you must pay it.

How do I file a claim for my vision and hearing benefit?

Dental Claims should be submitted by your provider. For Vision and Hearing claims, please use the Vision and Hearing Claim Form. Click Here for more claims information.

What is the status of my claim?

Claim status can be found under "My Health Plan claim status".

How do I appeal a claim?

Appeals must be submitted in writing via email to [email protected].

What is my member ID number and where can I locate it?

Your member ID number is a unique identifier that helps protect your identity and can be found:

• On your secure Member Dashboard.
• On your Dental ID card.
• By calling our Customer Care Team at (833) 653-6338