Warning

In-network dentists have contracted with the plan to provide services at negotiated rates, which typically results in lower out-of-pocket costs. Out-of-network dentists have not agreed to these rates and may charge more than the plan’s allowed amount.

You can use the provider directory in your member portal to search for in-network dentists. Network status can change, so it’s a good idea to confirm before each visit. In some plans, coverage is limited to in-network dentists.
For a complete listing of participating dentists, please visit Find a Dentist.
For a complete listing of participating vision providers, please visit Find a Vision Provider.

An out-of-network dentist is a provider who does not have a contract with your dental plan. Because there is no agreement in place, an out-of-network dentist can charge more than what your plan allows for a service. Some plans do not provide any out-of-network coverage.

In-network dentists have agreed to accept the plan’s allowed amount as payment in full. This means:

• Lower out-of-pocket costs for you
• No balance billing (you don’t pay the difference)
• More predictable costs

Yes, your plan may recommend or require a Pre-Treatment Estimate or Pre-Authorization for certain courses of treatment. Please review your Certificate of Coverage and Coverage Schedule for full terms and conditions.

Yes, each family member in the program may choose a different dentist or dental office.

Select Plan members are required to select a participating dentist prior to receiving coverage, but may select a different dentist or dental office for each family member in the program by going online or calling Customer Service at 888.518.5338.

ePPO and Discount Program members must use a participating network dentist, but are not required to select a dentist. Each family member in the program may also receive care from different participating dentists and dental offices.¹

PPO members may receive dental care from any licensed dentist and are not required to select a dentist. However, members should always consider using a participating network dentist to maximize their out-of-pocket savings. To learn more about in-network savings, visit EOB and select “In-Network Advantages” in the PPO section.

Select Plan members are required to select a participating dentist prior to receiving coverage. If a Select Plan member can change their selected participating dentist at any time by emailing through the online contact form or calling Customer Service at 888.518.5338. If notification is received by Dominion on or before the 20th of the month, the change will be effective on the first of the following month. All outstanding bills with the current dental office MUST be paid before the change will be made effective.

ePPO and Discount Program members must use a participating network dentist but may change dentists at any time.¹

PPO members may receive their dental care from any licensed dentist and may change dentists at any time. PPO members can maximize their out-of-pocket savings by using a participating network dentist . To learn more about in-network savings, visit EOB and select “In-Network Advantages” in the PPO section.

We want to provide you with the easy, convenient access to participating dentists. We have designated staff who develop our dental networks, and we are continually adding new dentists. For the most up-to-date listing, visit Find a Dentist. To request that your dentist be contacted about joining our networks, please click here.

An Explanation of Benefits (EOB) explains how a claim was processed. It shows what was billed, what the plan paid, and what you may owe. An EOB is not a bill.

You may receive a bill due to:

• Deductibles, coinsurance, or copays
• Services not covered under your plan
• Frequency limits (such as the number of cleanings per year)
• Charges above the allowed amount

Benefits will be paid to you or they may be assigned directly to your dentist. Your dentist may use the standard American Dental Association claims form. Claims can be filed electronically, faxed to 833.517.1939 or mailed to:
Dominion National
P.O. Box 211424
Eagan, MN 55121

Click here for an ADA Claim Form.

In-network vision providers are responsible for submitting claims. If you utilize out-of-network services, it is your responsibility to pay the provider in full at the time of service. You may then submit your claim and itemized receipts to NVA for reimbursement. Claims must be mailed to:
NVA Claims Department
P.O. Box 2187
Clifton, NJ 07015-2187

Claims may be denied or reduced for several different reasons, including because:

• The service is not covered
• A waiting period applies
• Frequency limits or annual maximum have been reached

There are many other reasons why a claim may have been denied or partially paid. Please refer to the explanation on your EOB.

You can review your EOB and benefit details in the member portal. If you still have questions, contact Member Services for assistance.

A plan year is the 12-month period your dental plan uses to track your coverage, deductible, and annual maximum. When a new plan year begins, your deductible and annual maximum reset.

Select Plan members should refer to their Description of Benefits/Services and Member Copayments.

Discount Program members should refer to their Description of Services and Member Fees.¹

PPO, ePPO and vision members should refer to their Coverage Schedule for information on covered benefits.

Make sure you carefully review the exclusions and frequency limitations listed in the document.

You will receive ID cards and additional information explaining the program in detail by email and/or mail.

A deductible is the amount you must pay out of pocket each plan year before the plan begins paying for certain services. Deductibles may not apply to all services. Please review your Certificate of Coverage and Coverage Schedule for more information about how your deductible works.

The annual maximum is the total amount your dental plan will pay for covered services during a plan year. Once this limit is reached, you are responsible for the full cost of services until the start of the next plan year.

The percentage of a covered dental service cost paid by insurance (as listed in the PPO Coverage Schedule). Please review your Certificate of Coverage and Coverage Schedule for more information about coinsurance.

Out-of-network dentists have not agreed to our contracted rates and may charge more than the plan’s allowed amount. Balance billing occurs when the out-of-network dentist’s fee is higher than the insurance plan’s reimbursement fee to the dentist and the member is billed the remaining balance to cover the additional costs. Using a participating network dentist helps maximize your benefits. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

• Preventive services often include cleanings, exams, and X-rays
• Basic services may include fillings and extractions
• Major services may include crowns, bridges, and dentures

Coverage levels vary by service category and plan.

Some dental plans require waiting periods before coverage begins for certain services. Waiting periods vary by plan. Please review your Certificate of Coverage and Coverage Schedule for more information about any waiting periods applicable to your plan.

Select Plan, ePPO and Discount Program members should get a referral from their general dentist.¹ The dentist will evaluate your condition and refer you to a participating specialist as needed.

PPO members may receive services from any licensed dentist, including specialists, without a referral from a general dentist. To maximum benefits, PPO members should visit a participating Dominion dentist. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

Below are some examples and descriptions of various dental specialists.

• Endodontist: Treats the roots and nerves of teeth.
• Oral Surgeon: Treats problems related to the hard and soft tissues of the face, mouth and jaws.
• Orthodontist: Treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures.
• Pediatric dentist: Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist.
• Periodontist: Treats diseases of the supporting and surrounding tissues of the teeth.
• Prosthodontist: Restores natural teeth and replaces missing teeth with artificial substitutes.

The Select Plan covers most pre-existing conditions, including coverage for missing teeth. The PPO program may have certain restrictions, which are best outlined in the pre-enrollment brochure, Certificate of Coverage, Coverage Schedule and other distributed materials.

Dominion's office hours are 8:30 a.m. to 4:30 p.m. Eastern, Monday through Friday. Service Team Associates are available from 7:30 a.m. to 6:00 p.m. Eastern, Monday through Friday, at 888.518.5338. After business hours, members have access to certain functions via our Interactive Voice Response (IVR) system.

You may also access your account 24/7 on Dominion’s secure member portal at DominionMembers.com.

Dominion understands that each of our customers is unique and has different communication preferences so we’ve created a variety of online tools to provide you with instant access to your account whenever and wherever you need it. To ensure you always have access to real-time benefit information, we encourage you to sign up for the below online resources where you may view your digital ID card, find a provider and more.

Member Portal
DominionMembers.com

Dominion National Go Mobile Communication Service
Register by calling 888.596.0716 or texting “DN GO” to 571.365.7461