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Dental Insurance

•    Dental benefits.•    Coordination of benefits.•    Choosing a dental provider.•    More information about the dental plans.

Dental benefits

If your employer participates in the dental plans offered through EGID, employees are eligible to enroll if they have health coverage through EGID or provide you with proof of other health coverage that is not an excepted benefit. Refer to Excepted Benefits in the Glossary section.

The dental plans offered through EGID provide benefits for preventive, basic and major restorative and orthodontic services. Benefits are subject to each plan’s rules and cost-sharing features such as copays, deductibles and coinsurance.

All the dental plans have certain benefit limitations and plan year maximums. Charges that exceed the annual maximum are handled differently by each dental plan. Some plans also apply a waiting period for orthodontic benefits. Check with each plan for benefit details.

The dental plans do not include prescription drug benefits. Dental prescriptions, written by licensed dentists, may be covered under the prescription drug benefits of the employee’s health plan.

Each plan issues ID cards to its members. Providers often require a copy of the employee’s plan ID card and driver’s license or photo ID when they receive services.

Coordination of benefits

COB is discussed in the Health Insurance section. The same rules and processes apply when a member has other group dental coverage. All dental plans offered through EGID coordinate benefits with other group dental plans.

Choosing a dental provider

If a prepaid dental plan is selected, the employee must designate a primary care dentist. If they do not designate a PCD, one is selected for them. The PCD is the first point of contact when seeking dental care and is responsible for coordinating and authorizing all dental care. Failure to obtain authorization from the PCD can result in denial of the claim.

If a dental indemnity plan is selected, the employee should confirm their providers participate in that plan’s network. The most current list of network providers is available on each plan’s website, or employees can contact the plan directly. If an employee decides to use a non-network provider, their out-of-pocket costs can be substantially higher.

More information about the dental plans

All the dental plans offered through EGID are available statewide, although provider access may be limited in some areas. Encourage employees to check each plan’s list of network providers before selecting a dental plan.

A current list of the available dental plans and a comparison of benefits for each plan can be found in the Employee Benefit Options Guide. Contact each plan for more details. Refer to the Contact Information section.

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