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 and 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 be sent ID cards and additional information that explains the program in detail by email and/or mail.
The annual amount each member must pay for dental services before the plan will begin to cover the member’s dental procedures. If dependents are covered, there may be a family deductible, which is the overall limit on what a family will pay before the dental plan pays.
The maximum dollar amount that the plan will pay toward the cost of dental care within the specified period per member. Maximum is shared for in-network and out-of-network services (if covered).
The percentage of a covered dental service cost paid by insurance (as listed in the PPO Coverage Schedule).
Out-of-network PPO dentists set their own fees, of which your insurance plan may only pay a portion (if covered). 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. Always consider using a participating network dentist to maximize your out-of-pocket savings. To learn more about in-network savings, visit EOB and select “In-Network Advantages” in the PPO section.
All plan options cover dependents up to age 26 unless otherwise determined by your employer or plan administrator.
Select Plan, ePPO and Discount Program members should get a referral from their general dentist. 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. For maximum benefits at the lowest cost, members should visit a participating Dominion dentist. To learn more about in-network savings, visit 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.
Select Plan subscribers are required to select a participating dentist and ePPO subscribers must use a participating network dentist. If a Select Plan or ePPO member is temporarily more than 50 miles away from home and requires emergency treatment for the care of an injury, toothache or accident, they may seek treatment from any dentist. Dominion will reimburse the member up to $100 (unlimited in the states of NJ and PA; and VA for pediatric only plans) for palliative treatment after submitting copies of their receipt to Dominion. Any member copayments that apply under the member’s plan will be deducted from the amount of the claim.
PPO subscribers may receive emergency dental services from any licensed dentist and file a claim as normal.
Discount Program subscribers must use a participating network dentist at all times and do not receive emergency dental services as part of their program.
The Select Plan and Discount Program cover most pre-existing conditions, including coverage for missing teeth. The PPO program may have certain restrictions, which are best described in the pre-enrollment brochure, Coverage Schedule and other distributed materials.