Frequently Asked Questions

Yes! We will send you a dental ID card after your first payment is made. We issue one ID card per family.

DHMO: DHMO stands for Dental Health Maintenance Organization. A DHMO offers affordable, preventative dental care for you and your family. DENCAP uses this model because it provides a cost-controlled way to take care of your smile before problems arise. With DENCAP you receive minimal waiting periods, high annual maximums, and significantly reduced costs on dental specialties and treatments. A DHMO allows you to maintain your healthy smile while containing costs for everyone.

PPO: A PPO plan is short for a Dental Preferred Provider Organization plan. Unlike a DHMO, a PPO has a much wider network of dentists you can visit and still receive at least partial coverage for. A PPO is also more likely to offer reimbursement for services from an out-of-network dentist.

DHMO: Each plan has a list of all your covered dental procedures and co-payments called the Schedule of Benefits. An easy way to think of the Schedule of Benefits is like a restaurant menu – you get to see ahead of time what everything is, and how much everything costs.You receive this schedule when you enroll with DENCAP. You can check your benefits by talking to your Primary Care Dentist, call us at 888-98-TEETH, or look in your enrollment packet.

PPO: The Benefits Summary is included in your Certificate of Coverage. If the information in the Benefits Summary is different from your Certificate of Coverage, the Benefits Summary applies.

DHMO: No. DENCAP is a DHMO and our convenient state-wide network is one way that we keep costs contained for everyone. You must use a Primary Care Dentist in network to use your plan benefits.

PPO: If the Dentist you select is not a PPO Provider, you will be charged the difference of the Maximum Allowable Amount and the Dentists fee for a service. You are only responsible for your Deductible, Copayments, and /or Coinsurance amounts as well as any fees above the Maximum Allowable Amounts for Covered Services.

In case of a dental emergency during normal business hours, call your Primary Care Dentist. An after hour’s care number is provided on the answering machine of your primary care dentist for your use.

DHMO: Your dental service area is 50 miles from your Primary Care Dentist. If you are outside of this service area, DENCAP will reimburse you for 50% of the emergency services you receive up to $100. Emergency services only include normally covered benefits and the relief of severe dental pain.

PPO: As long as you’re being seen by a DenteMax Network Provider, your coverage will be the same regardless of your location.

In most cases, yes! DENCAP follows all State Regulations. As a member, you are responsible for notifying your Dental Office of your dental insurance plan(s).

DHMO: You can view a list of our current providers in our provider directory that came with your enrollment materials. You can also search providers online with our Provider Locator tool. Once you have chosen an office that is best for you, you need to notify DENCAP of your new primary care dentist. Doing so is easy – just call, write, fax, or email to notify us of your selection.

PPO: View the link to the Dentemax network here.

DHMO: You can find out if your annual maximum has been met by contacting your Primary Care Dentist’s billing specialist. Your dentist will have a record of when your DENCAP plan renews.

PPO: Contact DENCAP’s PPO customer service line found on the back of your card.

Each enrolled individual has a separate annual maximum.

We would be happy to answer your questions. Give us a call using the number from the back of your card.

DENCAP Business Hours

Monday – Thursday 9 AM – 5 PM

Friday 9 AM – 3:30 PM

Enrolling with DENCAP is simple! Click here to begin the process or contact us at 888-98-TEETH and we will mail you an enrollment kit. If you are a member of one of our group/business plans, contact your human resources department to enroll.

You may enroll your spouse and your legal dependents as members.

In order to qualify for the Student Individual Value Plan, the member must be a full-time student and the primary subscriber of DENCAP. The student can enroll his/her spouse and legal dependents as members.

Yes! We allow child-only members as long as parent/guardian information is provided where indicated on the application.

Yes! If your coverage has been terminated you can pay for the lapsed months plus a $25 reinstatement fee. This process will reinstate you back to your original effective date. Alternatively, you may re-enroll after an 18 month waiting period from your last effective date.

You can cancel up to seven business days prior to your next premium due date. Cancellation notices must be in writing and received by mail (address below), email (enrollments@dencap.com), or fax (313) 972-4662. Include your name, subscriber ID number, and a brief reason you are cancelling your coverage.

DENCAP Dental Plans

45 E. Milwaukee St.

Detroit, MI 48202

Yes. Your dental ID card will be mailed to you after the first payment is received to active your DENCAP coverage.

Yes! Dental coverage can be purchased for anyone on an annual premium payment schedule. We would love to help you give this gift, please call DENCAP for details.

Visit the Gift of Dental dedicated page

Make updates by going to pay.dencapsecure.com or through mail, email, or fax. DENCAP requires seven business days’ notice prior to your next premium due date to implement your changes.

No. There are no additional or hidden fees for your plan. Please see your Schedule of Benefits for details on the services that require a co-pay when you visit the dentist.

No. As a cost containment measure we only collect monthly premiums on the 25^th of the month. Alternatively, you can choose to make an annual premium payment.

Payments methods are specific to the plan type. Please call DENCAP to check your payment options.

DENCAP’s premiums are due in advance of the coverage month to ensure you are covered prior to visiting your Primary Care Dentist.

You can see your Primary Care Dentist the day your plan becomes effective. Please see your Schedule of Benefits for details on waiting periods for Specialty Care.

The Schedule of Benefits is the listing of all covered procedures and the co-payments the patient is responsible for at the Primary Care Dental Office. All in-network Primary Care Offices will follow the Schedule of Benefits for covered procedures. A copy of the Schedule is available to you upon enrollment, and upon request.

DHMO: You can view a list of our current providers in our provider directory that came with your enrollment materials. You can also search providers online with our Provider Locator tool. Once you have chosen an office that is best for you, you need to notify DENCAP of your new primary care dentist. Doing so is easy – just call, write, fax, or email to notify us of your selection.

PPO: View the link to the Dentemax network here.

DHMO: Yes. To find a new Primary Care Dentist, you can view a list of our current providers in our provider directory that came with your enrollment materials. You can also search providers online with our Provider Locator tool. Once you have chosen an office that is best for you, you need to notify DENCAP of your new primary care dentist. Doing so is easy – just call, write, fax, or email to notify us of your selection.

PPO: Yes. To find a new Primary Care Dentist, please visit the DenteMax provider directory here.

DHMO: As a member of our DHMO plans, you pay a fixed co-payment. This is the part you pay to your Primary Care Dentist and does not change. Your Schedule of Benefits shows your fixed co-payments for procedures covered up to your allowable maximum.

PPO: As a member of our PPO plan, you pay a co-payment. This is a calculation based on plan coverage percentages, provider participation and allowable maximums. The percentages for procedure categories can be found on your Benefits Summary.

DHMO: You will only pay the co-pays shown on your Schedule of Benefits.

PPO: You will only pay the co-pay percentage shown on your Benefits Summary.

You will only pay the co-pays shown on your Schedule of Benefits. However, once you reach your annual maximum (many members never reach their annual maximum with DENCAP) or if you receive a procedure that is not a covered benefit then you will pay the Primary Care Dentist’s UCR fee.

Note: Once you reach your annual maximum or if you receive a procedure that is not a covered benefit, then you will pay the Primary Care Dentist’s UCR fee.

DHMO: First, contact your Primary Care Dentist’s billing specialist to understand if there was a billing error. If you still have concerns, please call DENCAP and we’ll do our best to figure out the situation.

PPO: N/A

Your annual maximum is calculated by subtracting your co-payment from your Primary Care Dentist UCR. The remainder is applied toward your annual maximum. Check your Schedule of Benefits for details. Many members never reach their annual maximum with DENCAP.

After your primary care maximum is reached you are responsible to pay your Primary Care Dentist’s UCR fee. Your primary care maximum is renewed annually on the first of the month in which you became eligible for care.

DHMO: When your Primary Care Dentist is unable to perform a complex dental procedure it is normal for him/her to refer you to a Dental Specialist. Typically these referrals are for non-preventative care procedures such as root canals or extractions.

PPO: Referrals are not needed for Specialty Care.

DHMO: To receive a referral to see a Dental Specialist you must first see your Primary Care Dentist who will then contact DENCAP on your behalf. Your eligibility, review of benefits, and determination for care will be completed within two business days after DENCAP has received your information from your Primary Care Dentist.

PPO: Your Primary Care Dentist will inform you when a specialist is needed, or you can find one yourself by visiting Dencap.com.

DHMO: No. Seeing a Dental Specialist is a covered benefit (some DENCAP plans have a short waiting period, please see your Schedule of Benefits for details) but one way that we keep costs contained for everyone is to ensure your Primary Care Dentist refers you. DENCAP cannot provide specialty care without a referral.

PPO: Yes.

DHMO: Some plans require up to a six month waiting period before you can receive care from a Dental Specialist. Please check your Schedule of Benefits for details.

PPO: No.

DHMO: No. In order to contain costs for everyone, preventative care is only provided by your Primary Care Dentist. Relatively rare and complex dental care is provided by our highly trained DENCAP Dental Specialists who are reimbursed at a higher rate.

PPO: Specialty is paid at a percentage based on your Benefits Schedule.

We cover endodontics for root canals, oral surgery for extractions, periodontics for acute gum care, and pedodontics for children age six and under.

After your specialty care maximum is reached you are responsible to pay your Dental Specialist’s UCR fee. Your specialty care maximum is renewed annually on the first of the month in which you became eligible for care.

DHMO: Yes! Your Primary Care Dentist may refer you to a DENCAP Orthodontic Specialist. Please check your Schedule of Benefits for details.

PPO: Yes! Your Primary Care Dentist may refer you, ot you can find your own by visiting dencap.com.