Frequently Asked Questions Do I need to have a health insurance plan in order to get a dental plan? No. Our Personal Dental Plans are standalone, meaning you can enroll whether or not you have a health insurance plan. Is there a waiting period before I can receive any dental services? Once your coverage is effective, waiting periods are dependent on the plan you have chosen. There are never any waiting periods for preventive or diagnostic services with any of our plans. The Personal Dental Plan Basic has a 6-month waiting period for basic restorative services. The Personal Dental Plan Plus has an 18-month waiting period for major restorative services. The Personal Dental Plan Comprehensive with Ortho 2000 has a 6-month waiting period for basic and restorative services and a 12-month waiting period for complex and orthodontic services. The Personal Dental Plan Comprehensive Plus with Ortho 1500 has no waiting periods except for orthodontics, which has a 12-month waiting period. Is there any cost for dental exams and cleanings? No. Preventive services, such as a checkup every six months, are covered completely, as are cleanings, polishings, fluoride treatments for children, and annual X-rays. What is a deductible and do these plans have them? A deductible is a set amount of money that an insured person must pay before his or her plan starts paying benefits. There are no deductibles for the Personal Dental Preventive Plan. The Personal Dental Plan Basic, Comprehensive with Ortho 2000 and Comprehensive Plus with Ortho 1500 have a $50 deductible per member with a maximum of $150 per family. The Personal Dental Plan Plus has a $100 deductible per member with a maximum of $300 per family. Deductibles never apply toward preventive treatment. Do I get to pick my own dentist? What if I want to change dentists? Yes, you may choose from DentaQuest’s extensive Personal Dental Plan network of qualified dentists and dental clinics. You are free to change your dentist at any time. Can I go to a dentist who is not in the DentaQuest network? If you are in AZ, GA, IL, MO, OH, or TX, you can use an out-of-network dentist; however, you will not receive network discounts on services you receive, so your out-of-pocket costs may be higher, depending on the dentist’s fees and policies. If you are in FL, IN, LA, PA, TN or VA, you will need to use DentaQuest’s personal dental plan network to receive services. You should check with your dentist before beginning care. How can I tell if a dentist is in the DentaQuest network? You can find a DentaQuest Personal Dental Plan network dentist or check if your current dentist is in the network by using our Find a Dentist tool, or calling the customer service number listed for your state. What if my dentist finds a cavity or other problem during an exam? Am I covered? Depending on your DentaQuest plan, you may receive benefits to help with such problems. With our Personal Dental Plan Basic, Personal Dental Plan Plus, Comprehensive with Ortho 2000, and Comprehensive Plus with Ortho 1500 you will receive benefits for fillings, crowns and other services. Is orthodontia covered under these plans? Orthodontia coverage is offered under the Personal Dental Comprehensive with Ortho 2000, and Personal Dental Comprehensive Plus with Ortho 1500 if it is offered in your state. Should I get an individual plan or a family plan? That depends on your needs. If more than one member of your family is NOT on a Medicaid or CHIP plan, a family plan might be the best choice. In a one-parent family with a child on a Medicaid or CHIP plan, an individual plan is probably the most cost-effective option. Do these dental plans have an annual benefit maximum? Annual benefit maximum means the maximum amount of money a plan will pay in benefits in a given plan year. For the Personal Dental Preventive Plan, there is no annual benefit maximum on preventive and diagnostic care. As each plan is different, we recommend that you check the plan details to find the annual benefit maximum. Definitions Deductible A set amount of money that an insured person must pay before his or her plan starts paying benefits. The deductible amount is defined by the plan. Coinsurance Coinsurance is when a portion of your medical or dental bill is paid by the insurance plan, and a portion of the bill is paid by the insured person. DentaQuest Personal Dental Plans' benefit summaries show the percentage of the bill that will be paid by the plan. For example, for a Type II service such as a filling, the Personal Dental Plan Plus will pay 40% of the cost (up to your annual benefit limit). Coinsurance percentages vary and are defined by the plan. Copay A fixed amount of money that an insured person must pay at the time of receiving a medical or dental service, or filling a prescription. Copays are defined by the plan. DentaQuest Personal Dental Plans do not have copays, although it is possible you may have to pay a copay from your medical insurance if you fill a prescription related to dental care you may receive. Annual Benefit Limit (or Annual Maximum) The maximum amount of money an insurance plan will pay out over the course of the one-year benefit period. Explanation of Benefits A document an insured person receives from the insurance company after a dentist’s visit, detailing which services were performed, the expected cost of those services, how much of those costs your plan will cover, and how much you may have to pay (such as deductible, coinsurance, services not covered by your plan, etc.).