Below are answers to commonly asked member questions. Please keep in mind that your Evidence of Coverage (EOC) or Certificate of Insurance defines the specific benefits of your plan.

DENTAL FAQs
PPO
Q11: What is a dental PPO?
Q12: Why should I use a PPO contracted dental provider rather than one that is not affiliated?
Q13: What is a deductible?
Q14: What is an annual maximum?
Q15: What is coinsurance?
Q16: Do I need pre-authorization for my dental work?
Q17: Do I need a referral to see a PPO specialist?

DENTAL FAQS: PPO

Q11: What is a dental PPO?
The primary distinction is that a PPO plan allows the member to choose either a contracted PPO network provider or any licensed dentist for covered services. You do not need to assign yourself or your covered family members to one particular dentist.

Q12: Why should I use a PPO contracted dental provider rather than one that is not affiliated?
Using a PPO contracted dental provider allows you to take advantage of our negotiated contract rate with our providers thus lowering a member's out-of-pocket costs.

Q13: What is a deductible?
This is the dollar amount of the covered charges (within a plan year) that the member must pay prior to the plan beginning to pay out benefits. Each member of the family has their own deductible (maximum of three deductibles per family) to meet in a benefit year.

Q14: What is an annual maximum?
An annual maximum is the maximum insurance benefit paid out by the plan for each covered member per calendar year. If a member has met the annual maximum no further benefits will be paid until the next calendar year.

Q15: What is coinsurance?
Coinsurance is the percentage of the fee charged by the dentist that is the member’s responsibility. For example: If a procedure is covered at 80% by the insurance company, the remaining 20% is the member’s responsibility.

Q16: Do I need pre-authorization for my dental work?
Although it is not a requirement to pre-authorize treatment, it is strongly recommended (for treatments over $300.00) so you will know in advance: 1) if the service is a covered benefit; 2) The benefit amount to be paid by the Plan; 3) how much you may have to pay for the treatment.

Q17: Do I need a referral to see a PPO specialist?
No, you do not need a referral to see a specialist. You can seek services from any licensed specialist. However, utilizing a PPO contracted specialist will allow you to take advantage of our reduced rates negotiated with the provider.

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