Dental Insurance FAQ



Dental Insurance FAQ

Dental Insurance
Frequently Asked Questions
1. Is orthodontic care included in the $1500 maximum benefit of the Premium Dental insurance plan?

A: Yes, the 50% orthodontic coverage would be included in the annual $1500 maximum.

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2. If the $1500 Premium Dental insurance maximum benefit has been met, are routine, preventative services still covered?

A: No, the $1500 is a total of all covered plan services per year.

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3. Who does employees contact when there is a problem with Direct Reimbursement paying a dental claim?

A: They should contact Direct Reimbursement. 770-683-1170 or 1-888-745-3274.

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4. What does “no fee schedule” mean in relation to our dental plans?

A. This means direct reimbursement doesn't set up a fee listing for customary charges. They will pay the percentage of the charges based on the type of care. For example, if one dentist charges $100 for a procedure and another $175, both would be paid at 100% for initial plan care, then 50% after the deductible is met. Employees should be informed consumers to get the best value for their money.

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5. Do you have to “prove” a dependent student’s eligibility every time you submit a dental claim?

A: Yes,you should provide proof of Dependent Student Eligibility/Status with each Direct Reimbursement claim.

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6. What must an employee do if they want to change their dental coverage from premium to basic?

A. The employee must complete the Open Enrollment Benefit Election Form to change from one dental plan to another, during the Open Enrollment period.

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7. What does "late entrant" mean as it pertains to dental insurance?

A. A late entrant refers to those individuals who were not previously covered by any dental benefit plan and chose not to enroll in the Direct Reimbursement plan when they were initially eligible.

If you are a late entrant, you will have reduced dental benefits for the period of time that you did not have dental coverage up to the first 12 months in the plan. Late entrants will have benefits reduced by 50% for the rest of the current plan year unless proof of previous coverage is provided, for the prior 12 months.

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8. When do I get my dental ID card?

A. There are NO dental ID cards.

Employees may go to the dentist of their choice, just take a dental claim form along with you for filing.

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