Q. How does my plan work?
A. You can start using your benefits by calling the dentist of your choice to set up an appointment. When you go to a dentist for treatment, either you or your dentist will file a claim with BEST Health Plans, and we will base payments on the level of coverage set by the plan your organization selected.
Q. How are benefits covered?
A. Your plan includes a calendar year maximum, a yearly deductible and coinsurance. Each of these helps BEST Health Plans determine how to pay your 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. 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 benefits, please refer to your plan’s Certificate of Insurance.
Q. My plan has a 12-month waiting period. How do waiting periods work?
A. Your plan comes with a 12-month waiting period for major and ortho services (if covered). This waiting period starts on your or your dependent’s effective date of coverage and is counted forward to 12 months. Once the 12-month waiting period is met, you or your dentist can file a claim for major and ortho treatment. Any major or ortho services received before the 12-month waiting period is met are not covered.
Q. Why should I see a network dentist?
A. With this dental plan you have the choice to select any licensed dentist or to receive out-of-pocket savings when you 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 you live in). When you see a CONNECTION Dental network dentist, your plan’s benefits are applied to the discounted amounts, which make your out-of-pockets lower than if you went to a dentist out of the network.
(To ensure that you receive in-network savings, please make sure the provider is part of the network before you make an appointment.)
Q. What is predetermination?
A. 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 find a network dentist?
A. We encourage you to refer to you Advantage Plus ID card to find out which network you can use and how to contact the network. You can also go to the “Locate a Dentist” link on this site, or call our Customer Service Department at 877.247.6778 for assistance.
Q. How do I file a claim?
A. Network dentists will file a claim on your behalf. If you are asked to file a claim, you can download a dental claim form by clicking on the “Download Forms” link on this site.
Completed forms should be mailed to:
BEST Health Plans
PO Box 890
Meridian, ID 83680-0890
