Frequently Asked Questions

Home About Us Frequently Asked Questions
  • General Questions
  • Enrollment & Billing
  • Primary Care
  • Specialty Care
General Questions
  • Are there any out-of-network benefits?

    You must seek services within the DENCAP Network in order to use your plans benefits. There are no out-of-network benefits unless it’s an emergency.

     

  • Can this dental plan coordinate with another dental insurance plan?

    If you have more than one dental coverage, contact your DENCAP Dentist’s billing department. They will know the process they use to bill each coverage and how those coverage’s can work together.

     

  • 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 DENCAP Dentist’s billing department. They have record of what dental services you have received and when your DENCAP Plan renews.

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

    Each member on the plan has their own annual maximum. It is not shared.

     

     

  • How much would dental treatment cost without coverage?

    There are significant savings from having dental coverage with DENCAP. Each dental office has its own fee schedule of UCR (usual, customary and reasonable) fees that it may charge to its patients. As a member, you are only responsible for the co-payments listed on your Schedule of Benefits (as long as you annual maximum has not been reached). If you want to determine your savings, ask your DENCAP Dental Provider for a treatment plan with their UCR fees and view your schedule for your co-payments.

     

     

     

     

  • What if I have a dental emergency?

    Dental emergencies can be handled by your DENCAP Primary Care Dentist. Often times, there are after hour emergency numbers given on a dentist’s answering service. If you are unable to get a hold of your DENCAP Dentist after hours, please call DENCAP at 888-98-TEETH.

  • What if I have an emergency out of town?

    If you are out of the DENCAP service area (50 or more miles away from your Primary Care Dentist), DENCAP will reimburse you or your covered dependent for 50% of the amount up to $100.00 for those emergency services which relieve severe pain or discomfort and are covered benefits.

  • What is a DHMO?

    A DHMO (Dental Health Maintenance Organization) is a model where the emphasis is on preventative dentistry and containing costs on other necessary dental care. DHMO plans have minimal waiting periods, high annual maximums, and reduced costs on dental treatments.

  • 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! Your vision ID card will be issued to you by Superior Vision,  2 weeks after enrollment.

Enrollment & Billing
  • Are there any fees associated with my dental premium?

    There are no additional fees for your plan above your dental premium. However, covered services may have a co-pay that you are responsible for when you visit the dentist.

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

    Currently, we only collect monthly recurring payments on the 5th and 25th of the month or you can choose to make your payments annually.

  • Can I mail in my monthly payment?

    Payment methods are specific to the plan type and the guidelines for payment are stated on the enrollment form. Please call DENCAP to check on your payment options.

  • Can I purchase coverage as a gift?

    Yes! You may purchase a gift of dental coverage for anyone. When purchasing dental coverage as a gift, the only payment option available is an annual payment. Please call DENCAP for details.

  • Can someone under the age of 18 enroll on their own plan?

    Yes! We allow child-only enrollments as long as guardian information is provided.

  • How can I cancel?

    DENCAP requires 7 days notice prior to your next charge date to cancel your coverage. Cancellation notices must be in writing and received by us through mail, email or fax.

  • How can I change/update my payment information?

    You may change/update your payment by calling DENCAP or sending something to us in writing by mail, email or fax. DENCAP requires 7 day notice prior to your next charge date to implement changes to your payment information.

  • How do I enroll?

    Enrolling with DENCAP is simple! You can submit an enrollment application online, by mail, email or fax. If you choose to enroll online, simply click the Enroll Now button in the top right corner and start the application process. You may also contact DENCAP and we will send you an enrollment kit. Once your enrollment is in process, we will contact you for any final details.

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

    If your coverage has been terminated you have an option to pay for the missed months of coverage, as well as a $25 reinstatement fee in order to be reinstated back to your original effective date. As an alternative, you must meet the 18 month waiting period in order to re-enroll in your coverage.

  • How many members can I have on my plan?

    You may have an unlimited number of legal dependents as members on your dental plan.

     

  • Who can enroll in the Student Individual Value Plan?

    In order to qualify for the Student Individual Value Plan, the student must be the subscriber of the plan and they can enroll their legal dependents as family members.

     

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

    DENCAP bills members one month in advance of the coverage month to ensure that a member is paying for the coverage prior to visiting a dentist.

     

  • Will I be billed separately for my vision coverage?

    Your dental and vision premiums are made in one single monthly payment.

     

  • 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.

Primary Care
  • Can my DENCAP Primary Care Dentist charge me differently than the co-pay listed on the Schedule of Benefits?

    No. The only time a DENCAP Primary Care Dentist can charge a member anything outside of the agreed co-payments is if the member has reached their annual maximum, or if they are receiving a procedure that is not a covered benefit.

  • How do I assign myself to a dental office location?

    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.

  • How is my annual maximum calculated?

    Your annual maximum is calculated by the DENCAP Dentist’s UCR (usual, customary and reasonable) fee less your co-payment, then the remainder is applied toward your annual maximum. Please check your Schedule of Benefits for co-payment and annual maximum details.

  • May I change my Dental Office Location?

    Yes! Changes are allowed as needed to ensure that you are completely satisfied with your dental experience. Members can change their dental location with a 2 week notice by mail, phone, email (info@dencap.com) or fax.

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

    First, contact your DENCAP Primary Care Dentist’s billing department to see if there was an error in billing. If you still have concerns, please call DENCAP.

  • What does a fixed co-payment mean?

    A fixed co-payment is the patient’s portion of the covered service (found on the Schedule of Benefits), paid at the time the service is rendered.

  • What if I have met my primary care maximum?

    After your primary care maximum is reached, you will be responsible to pay your DENCAP Primary Dentist’s full UCR (usual, customary and reasonable) fee. Your primary care maximum will be renewed annually on the first of the month in which you became eligible.

  • 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.

  • What is the waiting period for Primary Care Dentistry?

    All services are available at a DENCAP Primary Care Dental Office once your plan becomes effective. Specialty Care coverage may be subject to a waiting period. Please, check your Schedule of Benefits for details.

Specialty Care
  • Can I see a specialist without a referral?

    Seeing a Specialist is a covered benefit (some plans have waiting periods) but you MUST have a referral from a DENCAP Primary Care Dentist. There will be no coverage without a referral.

  • Does my plan cover Orthodontics?

    Yes! Your DENCAP Primary Care Dentist may refer you to see one of our in-network Orthodontic Specialists. Please, check your Schedule of Benefits for details.

  • Does the Specialist adhere to co-payments on the Schedule of Benefits?

    Specialists do not adhere to the co-payments on the Schedule of Benefits because of the additional certification and training that a specialist receives in order to perform procedures that cannot be completed by a primary care dentist. These specialized dentists receive a higher rate of reimbursement for covered procedures due to their ability to perform complicated dental treatment.

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

    Once your DENCAP Primary Care Dentist determines that you need Specialty Care treatment, he will forward the referral to DENCAP over the phone or in writing. DENCAP will confirm your eligibility, review your benefits and make a determination for Specialty Care within two business days.

  • Is there a waiting period to use my Specialty Care Maximum?

    Some plans may have up to a 6 month waiting period of continuous coverage before your Specialty Care Maximum can be used. Please, check your Schedule of Benefits for details.

  • What if I have met my specialty care maximum?

    Your specialty care maximum will renew annually, on the first of the month in which you became eligible to receive Specialty Care. If you have dental treatment between the time when you have met your annual maximum and the renewal date, the amount you will pay will be the specialist full UCR (usual, customary and reasonable) fee.

  • What type of dental specialties’ are covered?

    The DENCAP Dental Specialties’ covered include: Endodontics for Root Canals, Oral Surgery for Extractions, Periodontics for gum care, and Pedodontics for children dentistry (six and under).

  • Why do I need to see the Specialist?

    DENCAP Primary Care Dentists refer our members to specialty care when the treatment needed cannot be completed by the general dentist. In cases where your general dentist is unable to perform a given procedure, he/she may refer you to see a specialist within our network.