Texas Dental PPO

Q. How does the plan work?
A. Members can start using their benefits by calling the dentist of their choice to set up an appointment. When they go to a dentist for treatment, either the member or the dentist will file a claim form with BEST Life, and we will base payments on the level of coverage set by the plan your organization selected.

Q. How are benefits covered?
A. Your plan includes a calendar year maximum, a yearly deductible and coinsurance. Each of these helps BEST Life determine how to pay your claims:

1. Calendar Year Maximum: the maximum amount BEST Life will cover for that year.
2. Yearly Deductible: the amount each member must meet before claims are paid. In a family, only three members must meet this amount before claims are processed. Deductibles do not apply to preventive services.
3. Coinsurance: the percentage we will pay for a category of treatment procedures. There are three or four categories (Preventive, Basic, Major, and Orthodontia, if covered) and each category will have a different coinsurance.

For exact information on your benefits, please refer to your plan’s Certificate of Insurance.

Q. My plan has a 12-month waiting period. How do waiting periods work?
A. Your plan comes with a 12-month waiting period for major and orthodontic services (if covered). This waiting period starts on the member’s effective date of coverage and is counted forward to 12 months. Once the 12-month waiting period is met, a member or a member’s dentist can file a claim for major and orthodontic treatment. Any major or orthodontic services received before the 12-month waiting period is met are not covered.

BEST Life offers waiting period waivers to qualifying groups. In these cases, either those employees who have had prior continuous coverage will receive “credit” towards their waiting period, or the entire group’s employees, including new hires, will be waived from waiting periods. To find out more, please contact your BEST Life Account Manager or Broker.

Please note that your plan includes exclusions and limitations, these either explain how services are covered or provides a list of services excluded from coverage. Waiting periods do not have any affect on exclusions and limitations. If your plan’s waiting periods are waived, any limitations and exclusions will remain and cannot be waived.

An example is the missing tooth exclusion. The cost of a prosthetic device (a fixed bridge or denture) to replace teeth missing before you enrolled on this plan is not eligible for coverage until you have been continuously covered by this plan for at least three years. However, if your dentist needs to extract a tooth next to a missing tooth in order to install a new bridge or denture or expand an existing one, those costs do become eligible for coverage. This exclusion remains intact even if your group is waived from waiting periods.

Q. Why see a network dentist?
A. With this dental plan members have the choice to select any licensed dentist or to receive out-of-pocket savings when they go to a CONNECTION Dental network-contracted dentist.

Dentists contracted with CONNECTION Dental (offered through PPO USA) have agreed to provide dental services at a discounted price, which can translate to a savings off what would normally be charged (depending on the procedure and the area in which you live in). When you see a CONNECTION Dental network dentist, your plan’s benefits are applied to the discounted amounts, which make your out-of-pockets lower than if you went to a dentist out of the network.

(To ensure that you receive in-network savings, please make sure the provider is part of the network before you make an appointment.)

Q. What is predetermination?
A. Predetermination is an estimate of how BEST Life will cover a treatment recommended by your dentist.  Predetermination is required for any treatment a dentist estimates to cost over $300 or $500, depending on your plan, before any procedure is started.  By getting a Predetermination, BEST Life can ensure that you will have all the financial information you need to make an informed decision.

In most instances, your dentist will submit a Predetermination report to the BEST Life Claims Department.  Once we receive the report, BEST Life provides you and your dentist with an explanation of how your dental plan will cover costs.

When reviewing a Predetermination, BEST Life looks at the treatment being recommended, any discounts that would be applied for using a network contracted dentist (if applicable), the total billed costs, the estimated amount BEST Life would pay for the treatment, and the estimated amount you would be responsible for.

For more information on Predetermination, please refer to your Certificate of Insurance.

Q. How do I find a network dentist?
A. On the TX Dental PPO plan, members can visit the CONNECTION Dental website to locate a CONNECTION Dental network provider. We also encourage members to refer to their ID cards to find out how to contact the network. Members can also go to the “Provider Look-up” link on this site, or call our Customer Service Department at 800.433.0088 for assistance.

Q. How do members file a claim?
A. Network dentists will file a claim on a member’s behalf. If a member is asked to file a claim, they can download a dental claim form by clicking on the “Forms” link on this site.

Completed forms should be mailed to:

BEST Life and Health Insurance Company
PO Box 890
Meridian, ID 83680-0890