Frequently Asked Questions

Home About Us Frequently Asked Questions
  • General Questions
  • Enrollment & Billing
  • Primary Care
  • Specialty Care
General Questions
  • Will I receive a dental ID card?

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

  • Will I receive a vision ID card?

    Yes! Our vision partner, Superior Vision, mails your ID card two weeks after you enroll.

  • What is a 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.

  • What is a Schedule of Benefits?

    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.

  • Can I receive benefits outside of DECAP’s network?

    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.

     

  • What if I have a dental emergency?

    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. If you are unable to reach your Primary Care Dentist, call DENCAP at 888-98-TEETH

  • What if I have a dental emergency out of town?

    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.

  • Can DENCAP’s plan coordinate with another dental insurance plan?

    In most cases, yes! If you have more than one dental coverage, please contact your Primary Care Dentist’s billing specialist to understand the details and coordinate your coverage.

  • How much would dental treatment cost without DENCAP?

    Average costs for preventative care without coverage can really add up! Every dentist has a fee schedule or UCR (usual, customary, and reasonable) fees for service, so feel free to ask your Primary Care Dentist about those.

    As a member of DENCAP, you are only responsible for the co-payments listed on your Schedule of Benefits until you reach your annual maximum. Most DENCAP members never reach their high annual maximums, and enjoy healthy smiles with regular cleanings, x-rays, and dental care throughout the years.

  • How do I select my 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.

     

    Phone: 313.972.1400

    Fax: 313.972.4662

    Email: info@dencap.com

    Write: 45 E Milwaukee St. Detroit MI, 48202

  • How do I locate a vision provider?

    To find a Superior Vision Provider click here. To learn more about Superior Visio, click here.

  • How do I know when I have met my annual maximum?

    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.

  • How is the annual maximum applied to members on a couple or family plan?

    Each enrolled individual has a separate annual maximum.

     

  • What if I have more questions?

    We would be happy to answer your questions.

    Give us a call at: 888-98-TEETH (888-988-3384)

    Live chat during business hours with a benefits consultant using the link on the bottom right of the screen.

     

    DENCAP Business Hours

    Monday – Thursday 9 AM – 5 PM

    Friday 9 AM – 3:30 PM

     

Enrollment & Billing
  • How do I enroll in DENCAP?

    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.

  • How many people can I have on my plan?

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

     

  • Who can enroll in the Student Individual Value Plan?

    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.

     

  • Can someone under the age of 18 enroll as a member?

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

  • Can I re-enroll if my coverage has been terminated?

    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.

  • How do I cancel my plan?

    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 (info@dencap.com), or fax (313) 972-4662. Include your name, your policy number, and a brief reason you are cancelling your coverage.

     

    DENCAP Dental Plans

    45 E. Milwaukee St.

    Detroit, MI 48202

  • Will I receive a dental ID card?

    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.

  • Can I purchase coverage as a gift?

    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

  • How can I update my payment information?

    Make updates by calling DENCAP at (888-988-3384) or through mail, email, or fax. DENCAP requires seven business days’ notice prior to your next premium due date to implement your changes.

  • Are there any fees associated with my dental premium?

    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.

  • Can I choose a different recurring payment date other than the 5th or the 25th?

    No. As a cost containment measure we only collect monthly premiums on the 5th and 25th of the month. Alternatively, you can choose to make an annual premium payment.

  • Can I mail in my monthly premium?

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

  • Why is my premium collected prior to my coverage effective date?

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

     

  • Will I be billed separately for my vision coverage?

    No. Your dental and vision premiums are made in one monthly payment (or annually).

     

Primary Care
  • How long do I have to wait for my first visit to the 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.

  • What is the Schedule of Benefits?

    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.

  • How do I choose my Primary Care Dentist?

    To assign yourself to an in-network dental office location, you must notify DENCAP over the phone or by email (info@dencap.com). Our provider directory is your resource for making your selection. You can view it on-line or call us for a paper listing.

  • Can I change my Primary Care Dentist?

    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.

     

    Phone: 313.972.1400

    Fax: 313.972.4662

    Email: info@dencap.com

    Write: 45 E Milwaukee St. Detroit MI, 48202

  • What is a fixed co-payment?

    A fixed co-pay is the part you pay to your Primary care Dentist and does not change. Your Schedule of Benefits (link?) shows your fixed co-payments. As a member of DENCAP you pay only the fixed co-pay and we pay the remainder.

  • Will my Primary Care Dentist ever require me to pay more than the fixed co-pay?

    No. 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.

  • What can I do if my bill does not match the Schedule of Benefits?

    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.

  • How is my annual maximum calculated?

    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.

  • What if I have reached my primary care maximum but still need dental care?

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

Specialty Care
  • Why do I need to see a DENCAP Dental Specialist?

    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.

  • How do I receive a referral to see a DENCAP dental Specialist?

    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.

  • Can I see a DENCAP Dental Specialist without a referral?

    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.

  • Is there a waiting period to use my specialty care benefits?

    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.

  • Do DENCAP Dental Specialists adhere to co-payments on my Schedule of Benefits?

    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.

  • What type of dental specialties are covered?

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

  • What if I have met my specialty care maximum but still need specialty care?

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

  • Does my plan cover Orthodontics?

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