|
DHMO Member Guide
Thank you for selecting a CompBenefits dental plan.
You and your family can look forward to receiving affordable care as well as good
dental health. CompBenefits benefits are designed to encourage preventive care which
will keep your teeth and gums free of dental disease. When you receive care from
one of our Participating General Dentists or Participating Specialists, simply consult
your Schedule of Benefits to determine the amount you will pay for a specified procedure.
This amount is referred to as a co-payment or surcharge.
From time to time, you may have questions about your
dental benefits. We have anticipated what some of those questions may be and have
provided the answers for you below. Understanding how your new dental program works
will allow you to get the best care possible for both you and your family. Please
take a moment now to read this information and learn more about your dental plan.
Contents
Benefits are provided by Participating General Dentists
and Participating Specialists. The Participating General Dentist you have selected
is printed on your Certificate of Dental Benefits. If you have not already chosen
a Participating General Dentist, please contact Member Services in order to do so.
Please note that some Participating General Dentists may
have more than one office. Please be sure to go only to the physical office location
you choose. Each month, your dentist will receive a list with your name on it. It
is a good idea for you to check with your dentistā??s office staff to be sure your
name is on their list before you receive services.
Simply call your selected Participating General Dentist
and make an appointment. Please take a moment to confirm the effective date of your
coverage, which is printed on your Certificate of Dental Benefits. If you receive
your Certificate of Benefits prior to your effective date, please wait until your
effective date to make an appointment.
Simply call Member Services. We will be happy to mail one
to you.
If you need to cancel an appointment, please call your Participating
General Dentist at least 24 hours before your appointment. Dentists work on an appointment
basis and need to know your change of plans. If you break an appointment without
giving 24-hour notice to your Participating General Dentistā??s office, you may
be charged for a broken appointment at the rate shown on your Schedule of Benefits.
Your Participating General Dentist will evaluate your total
dental needs. The two of you will then agree on a treatment plan to correct any
existing problems and get you started on a program of good oral hygiene to help
keep your teeth healthy and sound. Be sure you understand the recommended treatment
plan and any associated charges. You may request a written copy of your treatment
plan.
Your dentist is a dental care professional. Please do not
ask him or her to provide only the "no charge" benefits and neglect treatment which
is in the best interest of your own oral health. If you have any questions about
your treatment plan, discuss them with your Participating General Dentist. If you
have questions regarding your Schedule of Benefits, contact Member Services.
You may get a second opinion from one of our Participating
General Dentists at the cost indicated on your Schedule of Benefits. Simply call
a Participating General Dentist and let the receptionist know that you'd like a
second opinion appointment. Be sure to indicate that you are a member. The dentist
will evaluate your situation and discuss it with you. If any services are rendered,
you will be responsible for the cost.
Call your Participating General Dentist and request an emergency
appointment for the treatment of accidental, painful or urgent conditions. Your
Schedule of Benefits shows the copayment for emergency appointments. This copayment
is in addition to any copayment for treatment.
If your Participating General Dentist is not available,
contact Member Services. We will help you locate another Participating General Dentist
who can provide emergency care.
Consult your Certificate of Benefits for specific information
regarding "out-of area" emergency care.
Your benefits are available only from Participating General
Dentists and Participating Specialists. Your Participating General Dentist will
provide most, if not all, of the care you need. In the event specialist care is
required, your Participating General Dentist may make a recommendation. Depending
on your plan's specific provisions, an authorized referral from your Participating
General Dentist may be required before seeking specialty care. Please read your
plan's Certificate of Benefits carefully for specific guidance about accessing specialty
care.
Simply notify Member Services by phone or letter if your
address or telephone number changes.
A few services are specifically listed as exclusions on
your Schedule of Benefits. You do not have any benefits for those services. Any
service that is not specifically excluded may be available at a discount from Participating
General Dentistsā?? Usual and Customary Fees. Please refer to your Schedule of Benefits
for the exact discount applicable to your plan.
Prophylaxis (ADA code #1110) is a routine cleaning.
It includes scaling and polishing of teeth with normal periodontium (gum attachment
and bone support).
Periodontal Maintenance Procedures (ADA code
#4910) are maintenance procedures which are often necessary for those patients who
have treatment for periodontal problems such as gum disease or pyorrhea and require
follow up care.
Periodic maintenance treatment following active
therapy is not the same as routine cleaning. It is a more extensive scaling process.
There is a scheduled co-payment for this procedure.
Yes. You may change your Participating General Dentist
by simply calling Member Services. If you request a change by the 15th of the month,
it will become effective on the first of the following month. You may be precluded
from transferring if you have a balance owed to your current dentist.
Please read your planā??s Certificate of Benefits
for details on dental facility transfer limitations.
Our plan is not an insurance plan. It is a Prepaid Dental
Plan which makes benefits available from selected Participating General Dentists
and Participating Specialists.
You enjoy benefits without deductibles, preexisting
conditions, or maximum benefit limitations. You, as the patient, pay your dentist
the co-payment amount stated in your Schedule of Benefits. The financial arrangements
for making these co-payments are strictly between the dentist and the patient. There
are no claim forms to be filed.
The amount you pay depends on the type of crown or
bridge which your Participating General Dentist recommends for you. The co-payment
on your Schedule of Benefits may not include the price of gold. If your crown or
bridge includes gold, there may be an additional charge.
Dental records are the property of the Participating General
Dentists or the Specialists. As a patient, you may request that a copy of your dental
records be forwarded to your new Participating General Dentistā??s office, however,
we cannot do this for you. Please note that there may be a charge to you for copies
of dental records, including X-rays.
We typically will be your primary coverage. However, you
may want to file your "out-of-pocket" expenses with your other carrier. Please contact
your other plan for information about how they would like you to submit your "out-of-pocket"
expenses.
We have qualified staff trained to answer your
questions. Please contact us for further information.
Contact Member Services for:
- Name of Participating General Dentist
- Change of Participating General Dentist
- List of Participating Dentists
- Explanation of benefits
- Change of address
- New Certificate of Benefits & ID Cards
Contact Account Services for:
- Billing/payment questions
- Continuation of coverage
- Continuation of coverage for dependents who have reached
the maximum age limit
- Policy reinstatement
- Dependent addition
- Dependent deletion
- Change of name
- Cancellation of coverage
- Effective date of policy
Helpful Numbers
To receive a free information packet in the mail,
please fill out this form.
|
