Individuals & Families
Forms and FAQ's
Forms
Enrollment & Change Forms
The forms below are for Individuals and Families who do not currently have employer coverage. Individual Plan forms are not for use with Employer/Group Plan employees. For employer coverage forms please access the Forms and FAQ's section under the Employer Section of this website.
Individual Plan Enrollment Form
Miscellaneous
Helpful Benefit Hints - Get the most out of your dental plan.
Automatic Bank Withdrawal Form
FAQ's for Members on an Individual and Family Plan
When will my monthly premium be drafted from my account?
Co-pay and Co-insurance plans
Your account will be drafted on or around the 16th of each month for the following month's premium. If you enroll on the plan after the 15th of the month, two(2) month's premiums will be drafted from your account on or around the 16th of the following month to include the current month and the following month's premiums. Thereafter, you will only be drafted for one month's premium on or around the 16th of the month.
Discount Plan
Your account will be drafted on or around the 16th of the month. If you enroll on the plan after the 15th of the month, two(2) month's premiums will be drafted from your account on or around the 16th of the following month to include the previous month and the current month's premiums. Thereafter, you will only be drafted for one month's premiums on or around the 16th of the month.
When will I be able to use my benefits? Waiting periods are determined by your plan contract.
-
Discount Plan - Discounts are available the day you enroll
-
Co-Pay and Co-Insurance Plans - Some benefits are subject to waiting periods, however, you are eligible from your effective date for discounted fees when visiting a network provider. Please refer to your summary of benefits included in your ID card booklet.
If I upgrade to a different plan, will my waiting periods start over? Specific waiting period rules apply when switching plans. Please contact Dental Select member services at 1-800-999-9789 for details.
I want to cancel my Individual/Family coverage. What form do I need to submit? You must submit a written request to cancel by letter, fax or email. Please send all cancellation requests to:
Dental Select
Attn: Eligibility Department
5373 S. Green Street, 4th Floor
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email: idp@dentalselect.com
The banking information for my Individual/Family plan has changed. What is the best way to get that information to Dental Select? Submit an Individual Plan Bank Draft Form. This form can be found under the Forms section of this page. Mail or fax the completed form to:
Dental Select
Attn: Eligibility Department
5373 S. Green Street, 4th Floor
Salt Lake City, UT 84123
Fax: (888) 998-8706
On a Co-Insurance - Platinum Network Plan, what is the maximum on Major services after my waiting periods are met? There is a $1,000 annual maximum, of which $500 can be used for Major services.
What are my benefits if I choose to see a specialist rather than a general practicioner? This varies according to your plan:
-
Co-pay Plan Specialists: You receive 20% off the in-network specialists' fee for covered services. Discount only - no benefit will be paid. There is no payment from Dental Select for specialist services.
-
Co-Insurance Plans: In network specialists - you receive 20% off the Specialist fee for covered services. You are responsible for the difference between the plan payment and the discounted Specialist's fee. For services from all Out-of-Network Specialists, you are responsible for charges exceeding the plan payment.
Can minor children be the primary subscriber on an insured plan?
Minor children are not legally responsible to make a valid contract, therefore they cannot be the primary subscriber on an insured plan.
Forms
Enrollment & Change Forms
The forms below are for Individuals and Families who do not currently have employer coverage. Individual Plan forms are not for use with Employer/Group Plan employees. For employer coverage forms please access the Forms and FAQ's section under the Employer Section of this website.
Individual Plan Enrollment Form
Miscellaneous
Helpful Benefit Hints - Get the most out of your dental plan.
Automatic Bank Withdrawal Form
FAQ's for Members on an Individual and Family Plan
When will my monthly premium be drafted from my account?
Co-pay and Co-insurance plans
Your account will be drafted on or around the 16th of each month for the following month's premium. If you enroll on the plan after the 15th of the month, two(2) month's premiums will be drafted from your account on or around the 16th of the following month to include the current month and the following month's premiums. Thereafter, you will only be drafted for one month's premium on or around the 16th of the month.
Discount Plan
Your account will be drafted on or around the 16th of the month. If you enroll on the plan after the 15th of the month, two(2) month's premiums will be drafted from your account on or around the 16th of the following month to include the previous month and the current month's premiums. Thereafter, you will only be drafted for one month's premiums on or around the 16th of the month.
When will I be able to use my benefits? Waiting periods are determined by your plan contract.
-
Discount Plan - Discounts are available the day you enroll
-
Co-Pay and Co-Insurance Plans - Some benefits are subject to waiting periods, however, you are eligible from your effective date for discounted fees when visiting a network provider. Please refer to your summary of benefits included in your ID card booklet.
If I upgrade to a different plan, will my waiting periods start over? Specific waiting period rules apply when switching plans. Please contact Dental Select member services at 1-800-999-9789 for details.
I want to cancel my Individual/Family coverage. What form do I need to submit? You must submit a written request to cancel by letter, fax or email. Please send all cancellation requests to:
Dental Select
Attn: Eligibility Department
5373 S. Green Street, 4th Floor
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email: idp@dentalselect.com
The banking information for my Individual/Family plan has changed. What is the best way to get that information to Dental Select? Submit an Individual Plan Bank Draft Form. This form can be found under the Forms section of this page. Mail or fax the completed form to:
Dental Select
Attn: Eligibility Department
5373 S. Green Street, 4th Floor
Salt Lake City, UT 84123
Fax: (888) 998-8706
On a Co-Insurance - Platinum Network Plan, what is the maximum on Major services after my waiting periods are met? There is a $1,000 annual maximum, of which $500 can be used for Major services.
What are my benefits if I choose to see a specialist rather than a general practicioner? This varies according to your plan:
-
Co-pay Plan Specialists: You receive 20% off the in-network specialists' fee for covered services. Discount only - no benefit will be paid. There is no payment from Dental Select for specialist services.
-
Co-Insurance Plans: In network specialists - you receive 20% off the Specialist fee for covered services. You are responsible for the difference between the plan payment and the discounted Specialist's fee. For services from all Out-of-Network Specialists, you are responsible for charges exceeding the plan payment.
Can minor children be the primary subscriber on an insured plan?
Minor children are not legally responsible to make a valid contract, therefore they cannot be the primary subscriber on an insured plan.
