Members

Frequently Asked Questions

Q. Where can I get information about my benefits?

A. You can access your benefits information 24/7 by logging in to the secure Member Connection and downloading your Member Handbook/Benefits Booklet. If you have questions about your benefits, you may also contact our Benefit Services Department at the number on the back of your ID card.

Q. Can I get a listing of the allowed amounts for covered procedures?

A. Your dentist can submit a predetermination for services to be performed. This lets you know what the out-of-pocket expense will be before services are rendered. You can also look up average charges for dental procedures before you visit the dentist using our new cost estimator! Log in to use our cost estimator.

Q. Will my spouse or covered dependents get an ID card with their name on it?

A. All cards are issued in the member's name. However, the card will indicate whether or not the policy has dependent coverage. Log in to print additional ID cards for your covered dependents.

Q. What is a predetermination?

A. A predetermination is a plan of treatment, completed by your dentist, for services that will be provided at a future date. You and your dentist will receive a reply as to whether the treatment plan is covered under your group’s benefits. You will also receive an estimated dollar amount for the planned procedure. A predetermination is recommended when dental services are expected to cost $250 or more. A predetermination is valid for 90 days and is subject to eligibility, benefit maximums and member status at the time services are provided.

Q. Do I need preapproval for major dental work?

A. No, we don't require a preapproval for services received, but we do recommend it for any non-emergency treatment plan of $250 or more. Please discuss this option with your dentist.

Q. Does my plan cover cosmetic dentistry?

A. Cosmetic services are not typically a covered service. However, your employer's plan is unique so you should check your Member Handbook/Benefits Booklet or contact our Benefit Services Department at the number listed on the back of your ID card to review your group specific dental benefits.

Q. Does my plan cover Orthodontic treatment?

A. Please log in to view your Member Handbook/Benefits Booklet. You may also contact our Benefit Services Department at the number listed on the back of your ID card to review your group specific dental benefits.

Q. How do I submit a change of address?

A. Contact your Human Resources/Benefits Department and give them your new information.

Q. I've recently married. How do I add my new spouse to my plan?

A. Congratulations! Just give your Human Resources/Benefits Department a call and tell your employer that you'd like to add a dependent to your coverage.

Q. How can I check the status of a claim?

A. You can check claims history by logging in to the secure Member Connection or by calling our Benefit Services Department at the number listed on the back of your ID card. Because of the large volume of claims received each day, please allow 10 - 14 business days for processing before contacting Benefit Services to confirm receipt of your claim.

Q. Do I need to submit a claim after receiving treatment or will my dentist handle it?

A. If you are on a network plan, dentists who participate will file the claim for you. If you see a dentist who is not in the network or doesn't participate, the dentist may either file the claim for you or require you to file the claim, this is also true if you are on a non-network plan. Whether you or your dentist files the claim, all claims must be submitted within twelve (12) months of the date services are completed. If the claim is for Orthodontic services, the claim should be filed at the time of the banding. New enrollees who are already in Orthodontic treatment when this coverage becomes effective or after a benefit waiting period is met, should file a claim upon enrollment or once the benefit waiting period has been satisfied.

Q. Where do I send a claim?

A. Claims can be sent by mail or fax. Submit claims by mail to the address listed on the back of your ID card. To submit by fax, send to 540.562.8038

Q. How can I find out how much I owe for dental services?

A. To see how much you might owe for planned dental services, log in to the secure Member Connection where you can access detailed benefits information and the new cost estimator. To find out what you owe for completed services, you can view or print copies of the Explanation of Benefits (EOB) for your dentist visits.

Q. How will I be reimbursed?

A. If you are on a network plan and see a participating network dentist, your claims will be filed for you.  You may be asked to pay any coinsurance and/or deductible that is due to the dentist on the day of your appointment. If you are on a non-network plan, or see a dentist that doesn't participate in the network you may be asked to pay all charges to the dentist at the time of treatment and also be required to submit the claim form for reimbursement. For any amounts due to be reimbursed after the claim is processed, a check will be mailed to the member.