How Your Dental Benefit Works
Your Dental Benefits at a Glance
Your Elderplan Plus Long-Term Care (HMO-POS D-SNP) plan adds dental as a supplemental benefit — including select preventive, diagnostic, and comprehensive services — at $0 copay. Your benefit is provided through DentaQuest, and you have the freedom to see in-network or out-of-network dentists. Prior Authorization may be required for some dental services.
Your Network at a GlanceÂ
| In-Network Dental Care | Out-of-Network Dental Care |
|---|---|
In-network dentists have agreed to provide services at a negotiated rate set by DentaQuest. If you visit an in-network dentist, you will not be billed more than the negotiated fee schedule on covered services. | If you visit an out-of-network dentist, make sure they will perform the covered services that you need. |
| Your cost: $0 copay on covered services. Your dentist submits the claim to DentaQuest on your behalf. | Your cost: $0 copay on covered services. Your dentist submits the claim to DentaQuest on your behalf, or if they bill you separately, you may submit the claim to DentaQuest. |
Benefits at a Glance
Preventive & Diagnostic Care
- Covered: Oral exams, cleanings, dental X-rays, screenings, and other preventive services
- Your cost: $0Â copay (in-network and out-of-network combined)
- Common frequency limits:
- Oral exam: 1 every 6 months
- Cleanings (prophylaxis): 1 every 6 months
- Bitewings: 1 every 6 months
- Panoramic film: 1 every 36 months
Key coverage rules: Coverage is limited to selected services.
Comprehensive Care
- Covered: Fillings, crowns, root canals, periodontal treatment, dentures, implants, and other restorative, endodontic, periodontic, prosthodontic (removable and fixed), maxillofacial, and oral surgery services
- Your cost: $0Â copay (in-network and out-of-network combined)
- Key coverage rules:
- Coverage is limited to selected service codes
- Frequency limits apply per ADA guidelines — generally 1 service per tooth, arch, or quadrant
Prior Authorization may be required.
How to Submit a Dental Claim
In-Network Visits: When you see an in-network dentist, your dentist submits the claim to DentaQuest on your behalf.
Out-of-Network Visits: The dentist will often submit the claim on your behalf. If they do not, you can submit the claim yourself. Claims must be submitted within 365 days from the date of service.
What to Include
- Full member name and Member ID number
- Full provider name and address
- List of dental services received with the corresponding ADA code(s)
- Proof of payment — an itemized receipt showing payment and a zero patient balance
Where to Send Your Claim
Mail or fax your completed claim to:
DentaQuest Claims
PO Box 2906
Milwaukee, WI 53201-2906
Or fax to: 262-834-3589
Payment will be sent to the address on file for your account. To update your address or get help submitting a claim, contact Member Services at 1-877-891-6447 (TTY: 711).
Processing time: Dental claims are paid within 30 days. An Explanation of Payment (EOP) will accompany your check payment.
Important Reminders
About Using Your Dental Benefit
Service limitations apply.
Coverage is limited to selected service codes. Frequency limits apply depending on the type of service.
Out-of-network benefits use in-network limits.
Benefits received from out-of-network dentists are subject to the same maximums, limitations, and exclusions as in-network benefits.
Informed consent.
Your dentist may ask you to sign an informed consent document detailing the risks, benefits, costs, and alternatives to all recommended treatments.
Get a coverage estimate before your visit.
Before receiving dental treatment, ask your dentist to request a coverage estimate from DentaQuest. This helps you understand exactly what your plan will cover for your proposed treatment, as well as any associated out-of-pocket costs. If your provider needs help obtaining this estimate, they can contact DentaQuest using the number on the back of your Elderplan Member ID card.