Claim Information

Learn how to file a claim for out-of-network providers. If you choose an in-network provider, your dentist will submit the claim for you.

Submitting Out-of-Network Claims

For out-of-network providers, you will initially pay out-of-pocket. To receive a reimbursement, fill out and submit a claim form. Coordinate with your dentist to fully complete the form.

  1. Obtain the claim form.
    • Download and print this PDF; or
    • Contact us at 1-866-605-2642 and we will physically mail you a copy.
  2. Complete the claim form.
    • Fill out your personal information in Parts 1-22, 36-37.
    • Coordinate with your dentist to provide information in Parts 23-35, 38-58.
  3. Submit the form.
    • Mail a physical copy of your form to this address.

      • Attn: Claims Unit

      P.O. Box 30567

      Salt Lake City, UT 84130-0567

    • If we have any questions, we will contact you for clarification prior to approval.
  4. Receive your reimbursement.
    • This process takes about 10-15 days on average.

No Need to File an In-Network Claim.

When using a dentist that is part of the Encore Dental® network, simply pay your co-payment and/or deductible. There is no need to submit a claim form.