Dental FAQs and Key Terms

 

Q: In what ways can we submit information to enroll employees?

A: Dental Select offers 4 enrollment options:

  1. Manual enrollment, which will require each employee to complete a paper enrollment form.
  2. Electronic EDI Enrollment, which requires submitting an 834 HIPPA compliant file for upload.
  3. Web Portal Administration, which requires an initial 834 file upload and then manual group administration via our web portal.
  4. Spreadsheet Enrollment, which requires an excel spreadsheet that will be emailed for entry into our system.

 

Q: When can employees start using their benefits?

A: After your effective date, new hire or other applicable waiting periods, your employees can begin using dental benefits. Any services started prior to this date will likely not be covered. If you are unsure, you can verify eligibility with a Customer Care representative at any time.

 

Q: How soon will employees get their ID cards?

A: ID cards will be mailed to either the member or employer, as specified, and will arrive approximately 7 – 10 working days from the time Dental Select receives the enrollment or change form. If an employee loses their ID cards, they can also be accessed through the Dental Select mobile app or by logging into the member web portal.

 

Q: How do employees log in to the web portal?

A: To access the web portal, click here. A member ID will be required the first time you visit.

Here, your employees will be able to:

  • Access your plan documents
  • Order ID cards (or print a temporary)
  • Review benefits
  • Update personal information
  • View a claim’s status

Invoices, EFT, enrollment, Id cards, changes, COB

 

Q: Who can change information?

A: Depending on the type of information, both you (employer) and employees can add or request to change eligibility information. This can be done by logging into the  or filling out the Employee Change Form. All changes/updates must comply with eligibility guidelines.

 

Q: How long is the time period to enroll?

A: Your new employees and their dependents have 30 days to enroll from the time they are eligible to receive benefits. If the employee chooses not to enroll, they can wait until next year’s open enrollment or they may enroll within 30 days of a qualifying event. ID cards will be sent approximately 7 – 10 days from the time we process enrollment information.

 

Q: What is the difference between open enrollment and qualifying events?

A: A qualifying event can be marriage, divorce or legal separation, birth of a child or adoption of a child, loss of employment, new employment, loss of other coverage or gaining coverage, or death of insured. For more information, check out details here.

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Key Dental Terms

Annual Maximum (Max): A maximum dollar amount that a plan will pay towards costs incurred by an individual during the 12-month benefit period.

Claim Form: A standard form most commonly submitted by dentist that requests a payment of benefits for services provided. Claim forms are also used when requesting a pre-determination of benefits.

Co-insurance: The subscriber’s share of costs for services, usually figured as a percentage of the total charge.

Co-pay: The fixed dollar amount required at the time service is rendered.

Deductible: A portion of dental care expenses that must be paid by an individual before their dental plan pays benefits.

Dependent: A child or person for whom another person such as a parent or relative may claim a personal exemption tax deduction. A dependent is a member but not the subscriber on the plan.

Effective Date: The date insurance coverage starts.

Eligible Dependent: A dependent of an insured person who is eligible for dental coverage.

Eligible Employee: An employee who is eligible for benefit coverage, based on the requirements of their employer’s dental plan.

Fee Schedule: Fee schedules have set fees that are updated annually, are not contingent upon individual conditions and do not vary within that year. Contracted dentists have agreed to use Dental Select’s fee schedules with discounted rates.

Member: Any individual enrolled and covered by a Dental Select plan. Both the subscriber and the dependent are considered members.

Member ID: A unique number assigned to identify an individual covered by a Dental Select plan.

Open Enrollment: The period of time when eligible employees and their dependents can enroll or make changes to their Dental Select plan.

Reasonable and Customary (a.k.a. R&C or UCR): Dental Select claims payments for non-contracted dentists are limited to R&C amounts. R&C amounts are determined using a combination of national data and historical submitted claims data from dentists.

Subscriber: (a.k.a. employee): The person whose employment makes him or her eligible for group dental benefits. All others enrolled on the plan are dependents.

Waiting Period: The time that must pass before some of your benefits can begin.