Frequently Asked Questions
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Plan Eligibility
Plan Details
Dentists and Networks
Plan Eligibility
Q. I haven't been to the dentist in a long time. Does that make a difference in my rate or coverage?
A. Absolutely not!
Q. What is guaranteed acceptance?
A. Regardless of your current or past dental history, your acceptance into this plan is guaranteed as long as you are between the ages of 18-99 and live in an approved state.
Q. Do these plans cover children?
A. Yes!
For the Standard A & B plan, children are covered up to age 19 (25 if still in school and unmarried). For TX residents, children and grandchildren are covered up to age 26 if unmarried. For IN residents, children are covered up to age 24.
For the 1-2-3 and the Supplemental plan, children are covered up to age 19 (25 if still in school and unmarried).
Q. Will my same-sex partner/domestic partner be eligible for spouse coverage?
A. If the law in your state does not recognize same-sex marriages, then your partner will not be eligible for spouse coverage.
Plan Details
Q. How many check-ups and cleanings does the plan cover?
A. Both of our primary insurance plans pay for 2 check-ups and cleanings at the dentist EVERY year! Preventative and Diagnostic services are not covered by our Supplemental Insurance Plan.
Q. Does this plan cover tooth extractions?
A. Absolutely! Tooth extractions (oral surgery) are covered by all plans. Waiting periods for this procedure will vary depending on the plan you choose. Please check the Product Benefits page for full details.
Q. Do any of these plans cover braces or orthodontia?
A. Not yet! We are currently developing a product for child orthodontia. Please check back often for updates.
Q. What is an annual deductible?
A. Each year, you will have an annual deductible which is the amount you will pay out-of-pocket before benefits are paid. This amount does not include co-payments.
Q. Do these plans have a "deductible" each year?
A. There is NO deductible for preventative and diagnostic dental care. For basic or major dental work, you pay the first $50 each year (your deductible). For family coverage, there is a $150 maximum deductible per family, per year.
Q. What does “usual & customary” mean?
A. The average cost a dentist charges for services in your area.
Q. Will the Supplemental Insurance plan work with my current insurance?
A. Yes! Our Supplemental Insurance plan is designed to work with your existing coverage, regardless of who your primary insurer is. There will be a Coordination of Benefits to ensure that you receive the benefits of both your primary insurance coverage and your Encore DentalSM Supplemental Insurance coverage.
Q. What is Coordination of Benefits?
A. Coordination of Benefits is when benefits under one plan are coordinated with benefits from another insurance plan (that covers the same benefits), so payments won't be duplicated.
Q. Will my premium increase?
A. You will never be singled out for a premium increase due to your claims or usage. Premiums are guaranteed to stay the same for the first twelve months. After that, premiums could increase on an annual basis.
Q. Are there penalties if I cancel the coverage?
A. You have the right to cancel this coverage at any time for any reason. If you cancel this coverage, we can reject any new dental insurance application/enrollment form you submit during the one year period following the date of cancellation. Coverage can stop if 1) the Group Policy stops, 2) coverage is cancelled for everyone in your class, or 3) the insured performs an act of fraud or makes a material misrepresentation regarding this coverage. If coverage is to be discontinued due to reasons 1 or 2, we will notify you 60 days in advance.
Q. What are the waiting periods?
A. The waiting period depends on the plan you choose. With the Encore DentalSM 1-2-3 Insurance Plan there are no waiting periods for any type of service – including Major! Our Encore DentalSM Standard Plan A or Plan B has no waiting period for Preventative and Basic services, and a 12 month waiting period for Major services. Our Supplemental Insurance Plan has no waiting period for Basic services and a 6 month waiting period for Major services. Please check the Product Benefits pages for full details.
Dentist and Networks
Q. Do I have to use one of the plan's network dentists or can I see my own dentist?
A. You can see your own dentist or ANY dentist you like. You do NOT have to use a network dentist. Of course, you may find you will have less out-of-pocket expenses if you choose to use a network dentist because they all guarantee to charge lower pre-negotiated prices to Encore DentalSM certificate holders.
Q. How do I find out if my current dentist is in the network, or how do I locate a network dentist?
A. Click on our “Find a Dentist” link, or call 1-866-605-2642. Please remember, you do not have to use an in-network dentist for this plan to provide coverage. You have the flexibility to use any licensed dentist and still receive benefits for covered services.
Q. What are advantages of using an in-network dentist?
A. In-network dentists agree to charge fixed, pre-negotiated prices for their services which can provide you an opportunity to save more. In addition, when using a network dentist you do not have to submit a claim form - they will handle the claim’s paperwork for you.
Q. How are my claims reimbursed?
A. When going to an in-network dentist, there are no claim forms. The dentist will submit the bill for you. When going to an out-of-network provider, you will submit a claim form and then we will send you a check for what your benefits covered. You can obtain a claim form by selecting the “Claim Information” link located at the top of the page or by calling 1-866-605-2642. |
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