Members
Forms and FAQ's
Forms
Change Forms
Miscellaneous
Provider Referral Form - Typeable
Vision
EyeMed Vision Out-of-Network Claim Form
FAQ's for Members on an Employer Plan
When will I be able to use my benefits? Effective dates may be subject to a New Hire Waiting Period, per the employer's contract.
I received my ID Card and benefit booklet, am I eligible for coverage? Your eligibility is subject to the effective date determined by your employer and any New Hire Waiting Periods. If you are unsure, please check with your employer benefits administrator or Dental Select member services before seeking services.
What is a "Missing Tooth Clause"? Any missing tooth lost prior to Dental Select coverage will be subject to a 3 year waiting period before Dental Select pays any benefit for the service in question.
I want to cancel my coverage through my employer. What forms do I need and where should I send them? Contact your employer's benefit administrator to request a plan cancellation. All eligibility rules will apply.
What are my benefits if I choose to see a specialist rather than a general practicioner? For In-Network Specialists, benefits are paid off of a contracted specialist fee schhedule which represents 20%-30% savings. You are responsible for the difference between the plan payment and the discounted specialist's fee. Out-of-Netowrk specialists, you are responsible for charges exceeding the plan payment.
As a current Dental Select member, can I choose to enroll on an insured Vision Plan? Preferred Plus, Premier and Premier Plus Insured Vision Plans are only available if your employer included one of these plans in your Dental Select benefits portfolio. These are comprehensive, insured vision plans that offer a variety of benefits. Contact your employer benefits administrator for details.
Will my implants be covered? Implants are cosmetic. They are not covered unless stated in the group contract. Refer to your summary of benefits included in your ID Card booklet.
What services are included in my deductible? Preventive services are not typically included in your deductible. ADA Code D0140 - Emergency Exam, is not a preventive service. Please refer to your summary of benefits included in your ID card booklet.
Forms
Change Forms
Miscellaneous
Provider Referral Form - Typeable
Vision
EyeMed Vision Out-of-Network Claim Form
FAQ's for Members on an Employer Plan
When will I be able to use my benefits? Effective dates may be subject to a New Hire Waiting Period, per the employer's contract.
I received my ID Card and benefit booklet, am I eligible for coverage? Your eligibility is subject to the effective date determined by your employer and any New Hire Waiting Periods. If you are unsure, please check with your employer benefits administrator or Dental Select member services before seeking services.
What is a "Missing Tooth Clause"? Any missing tooth lost prior to Dental Select coverage will be subject to a 3 year waiting period before Dental Select pays any benefit for the service in question.
I want to cancel my coverage through my employer. What forms do I need and where should I send them? Contact your employer's benefit administrator to request a plan cancellation. All eligibility rules will apply.
What are my benefits if I choose to see a specialist rather than a general practicioner? This varies according to your plan.Specialists include: Pediatric Dentist, Endodontist, Oral Surgeon, Orthodontist, Periodontist and Prosthodontist.
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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.
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PPO and PPO Indemnity Plans:
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Dental Select Network: You receive 20% off the specialist fee for covered services. After discount, plan payment is based on the General Dentist fees. You are responsible for the difference between the plan payment and the discounted specialist's fee.
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Connection Dental Network (For Platinum Network plans only): All payments made by the plan are based on the Connection Dental Fee Schedule. No additional discounts apply. Orthodontics - The maximum charge allowed is $3,800.
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Non-Contracted Specialists: You are responsible for charges exceeding the plan payment for all services.
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As a current Dental Select member, can I choose to enroll on an insured Vision Plan? Preferred Plus, Premier and Premier Plus Insured Vision Plans are only available if your employer included one of these plans in your Dental Select benefits portfolio. These are comprehensive, insured vision plans that offer a variety of benefits. Contact your employer benefits administrator for details.
Will my implants be covered? Implants are cosmetic. They are not covered unless stated in the group contract. Refer to your summary of benefits included in your ID Card booklet.
What services are included in my deductible? Preventive services are not typically included in your deductible. ADA Code D0140 - Emergency Exam, is not a preventive service. Please refer to your summary of benefits included in your ID card booklet.
FAQ's for Members on an Individual and Family Plan
When will my monthly premium be drafted from my account? Your premium will be drafted on the 15th of each month.
When will I be able to use my benefits? Waiting periods are determined by your plan contract.
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Discount Plan - Discount are available the day you enroll
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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, Suite 400
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email: Eligibility_Web@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, fax or email the completed form to:
Dental Select
Attn: Finance Department
5373 S. Green Street, Suite 400
Salt Lake City, UT 84123
Fax: (888) 998-8706
Email: Finance_Web@dentalselect.com
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
Change Forms
Miscellaneous
Provider Referral Form - Typeable
Vision
EyeMed Vision Out-of-Network Claim Form
FAQ's for Members on an Employer Plan
When will I be able to use my benefits? Effective dates may be subject to a New Hire Waiting Period, per the employer's contract.
I received my ID Card and benefit booklet, am I eligible for coverage? Your eligibility is subject to the effective date determined by your employer and any New Hire Waiting Periods. If you are unsure, please check with your employer benefits administrator or Dental Select member services before seeking services.
What is a "Missing Tooth Clause"? Any missing tooth lost prior to Dental Select coverage will be subject to a 3 year waiting period before Dental Select pays any benefit for the service in question.
I want to cancel my coverage through my employer. What forms do I need and where should I send them? Contact your employer's benefit administrator to request a plan cancellation. All eligibility rules will apply.
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. Excludes Pediatric Specialist on the Gold Network. For Gold Network Co-pay plan pediatric specialist benefits, refer to schedule of co-payments.
-
PPO and PPO Indemnity Plan Specialists: 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.
As a current Dental Select member, can I choose to enroll on an insured Vision Plan? Preferred Plus, Premier and Premier Plus Insured Vision Plans are only available if your employer included one of these plans in your Dental Select benefits portfolio. These are comprehensive, insured vision plans that offer a variety of benefits. Contact your employer benefits administrator for details.
Will my implants be covered? Implants are cosmetic. They are not covered unless stated in the group contract. Refer to your summary of benefits included in your ID Card booklet.
What services are included in my deductible? Preventive services are not typically included in your deductible. ADA Code D0140 - Emergency Exam, is not a preventive service. Please refer to your summary of benefits included in your ID card booklet.
FAQ's for Members on an Individual and Family Plan
When will my monthly premium be drafted from my account? Your premium will be drafted on the 15th of each month.
When will I be able to use my benefits? Waiting periods are determined by your plan contract.
-
Discount Plan - Discount 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, Suite 400
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email: Eligibility_Web@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, fax or email the completed form to:
Dental Select
Attn: Finance Department
5373 S. Green Street, Suite 400
Salt Lake City, UT 84123
Fax: (888) 998-8706
Email: Finance_Web@dentalselect.com
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. Excludes Pediatric Specialist on the Gold Network. For Gold Network Co-pay plan pediatric specialist benefits, refer to schedule of co-payments.
-
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.
