Q. Are there any waiting periods on this plan?
If your group had less than 10 employees enrolling at initial enrollment, then your plan comes with a 12-month waiting period for major and ortho services (if covered). This waiting period starts on the member’s effective date of coverage and is counted forward to 12 months. Once the 12-month waiting period is met, a member or a member’s dentist can file a claim form for major and ortho treatment. Any major or ortho services received before the 12-month waiting period is met are not covered by the plan.
Q. Do members need to select a provider before they enroll?
There is no need to select a provider before enrolling. With this dental plan members have the choice to select any licensed dentist or to receive out-of-pocket savings when they go to a CONNECTION Dental contracted dentist.
Dentists contracted with CONNECTION Dental (offered through PPO USA) have agreed to provide dental services at a discounted price, which can translate to a savings of 25% to 57% off what would normally be charged (depending on the procedure and the area in which members live in). When members see a CONNECTION Dental network dentist, the plan’s benefits are applied to the discounted amounts, which make their out-of-pockets lower than if they went to a dentist out of the network.
(To ensure that they receive in-network savings, please encourage your employees to confirm if the provider is part of the network before they make an appointment.)
Q. What if an employee needs to see a specialist?
With this plan, members may self-refer to any specialist within the network without needing any preauthorization.
Q. How are benefits covered?
The plan includes a calendar year maximum, a yearly deductible and coinsurance. Each of these helps BEST Health Plans determine how to process claims:
- Calendar Year Maximum: the maximum amount BEST Health Plans will cover for that year.
- Yearly Deductible: the amount each member must meet before claims are paid on a yearly basis. In a family, only three members must meet this amount before claims are processed. Deductibles do not apply to preventive services.
- Percentage Payable: the percentage we will pay for a category of treatment procedures. There are three or four categories (Preventive, Basic, Major, and Orthodontia, if covered) and each category will have a different percentage.
For exact information on your plan's benefits, please refer to your plan’s Certificate of Insurance.
Q. What is predetermination?
Predetermination is an estimate of how benefits will be processed, and is a great way to ensure the members have everything they need to make informed decisions. Any treatment a dentist estimates to cost in excess of $500 (depending on the plan) is required to be reported to us before any work is done. Once we receive a report, BEST Health Plans will then provide our member and their dentist with an explanation of how the dental plan will cover costs.
Q. How do I file a claim?
Network dentists will file a claim on a member's behalf. If a member is asked to file a claim, a dental claim form can be downloaded by clicking on the “Download Forms” link on the member's website.
Completed forms should be mailed to:
BEST Health Plans
PO Box 890
Meridian, ID 83680-0890
Q. What if I have more questions about my organization's plan?
Depending on your questions, BEST Health Plans has several departments that can assist you. To find out who to contact, refer to our contact directory. |
