Personal plans
Is dental an essential benefit for adults?
No
Who is delegate for enrollment anddemographic/plan changes for HIX?
The federal health care marketplace (healthcare.gov)
Are ID cards send automatically every year?
not automatically generated each year but may be requested as necessary.
How do I know if a provider is in network?
Must be participating with "DQ Commercial Network"
How can a member submit an appeal?
A member or provider may file an appeal either orally or in writing.
For how many states do we offer D2C plans?
AZ, FL, GA, IL, IN, LA, MA*, MO, OH, PA**,TN, TX, VA
13
What is the The Federally Facilitated Marketplace (FFM)?
is an open marketplace from which you purchase health and dental insurance, from various insurance carriers.
How many cards are mailed per request? and under what name?
2 per request and subscribers name
What is the network for PDP and HIX?
Dentaquest commercial networks
What is the time limit to submit a claim?
12 months
What are the options for payments?
Members have the option to pay by check; or may register an account on our secure Member Web Portal to pay via automated clearing house (ACH) or credit card
When is open enrollment?
November 1st – December 15th of each year.
What is time frame to wave waiting period?
•Waiting periods will be automatically waived when member had previous comparable coverage and less than a 60-day gap in coverage.
NO
What is the claim address?
•DentaQuest Claims
PO BOX 2906 Milwaukee WI 53201-2906
•Payer ID: CX014
•Fax: 262-834-3589
In order to be effective for the 1st of the following month, paper enrollment forms (TX only) when should the postmarked??
by the 10th of the previous month.
What are the qualifying events for HIX enrollment?
•job loss, marriage, or divorce may allow for a special enrollment period.
Who can I sent request to remove waiting period?
BostonHIXEscalations@greatdentalplans.com
Does PPO plans have out of network coverage?
YES
How long does it takes for an appeal to get resolved?
30 calendar days
What are the plans available under personal accounts??
o Personal Dental Plan Preventive
o Personal Dental Plan Basic
o Personal Dental Plan Plus
What are the plans available under HIX enrollment?
•o Marketplace Family Pediatric Plan
•o Marketplace Family Low Plan
•o Marketplace Family High Plan
Who can I contact to make demographic changes for plans:
Marketplace Plans
State Exchange
Individual Plans
*Marketplace Plans – the member must contact the Marketplace
*State Exchange – Contact State Exchange
*Individual Plans – the member can update through:
o Self-service via their member portal
o Application / Change form (TX only)
o Email customer service at
Customer.Care@dentaquest.com
what is the phone number for credentialing?
•Provider Enrollment and Credentialing 1-800-233-1468
What business unit do you need to use?
Government business