Members' Frequently Asked Questions

FREQUENTLY ASKED QUESTIONS:

Question: Do I need to see a network dentist for services to be covered under this plan?
Answer: Yes. Services covered under the plan are available at the rates (copayments) specified in your Schedule of Benefits at participating dental offices only. The only exception is if you are out of the service area and have a dental emergency. Please refer to your Evidence of Coverage document for specific instructions for care and reimbursement when outside the Plan’s designated service area.

Question: Are there any waiting periods?
Answer: Once you meet the enrollment guidelines for your company, there are no waiting periods once your coverage is effective with SmileCare.

Question: Can I change dentists?
Answer: You may choose a new dentist by calling our Customer Services Department. In most cases your transfer will become effective on the first of the month following your request.

Question: Does everyone in my family have to go to the same dentist?
Answer: You and your dependents may select different dentists.

Question: What if I need to see a specialty care provider?
Answer: Under the SmileCare DHMO plan, specialty care is handled through a referral process that is initiated and requested by your selected general dentist. Once approved, Smilecare will provide you with a copy of the approval and the name and location of a contracted specialty care dentist in your area.

Question: What if have an emergency and am not near a SmileCare dentist?
Answer: If you are away from home and experience a dental emergency, call SmileCare and we will give you the appropriate instructions so you can receive the necessary dental services. If it is after business hours and you cannot reach our Customer Services department, you may see any dentist for relief of pain, and you will be reimbursed for the treatment (see your Evidence of Coverage document for specific instructions for care and reimbursement when outside the Plan’s designated service area).

Question: Will I get an ID card?
Answer: Yes. SmileCare will send you an I.D. card when your enrollment application is processed. An I.D. card is not necessary for you to receive services, as your selected dentist will verify your coverage and benefits with SmileCare.

Question: Who can I call if I have other questions?
Answer: SmileCare will be happy to answer any questions about your plan or provide additional assistance, simply contact us at (800) 32SMILE.