Dental Plan FAQs

We have answers for using your Dental plan.

What information do I need to access my account when I call you?

Your name, subscriber number, patient name, date of birth, and the date of service in question. If you have a related Explanation of Benefits, have it handy when you call us.

Can I see any dentist I want?

Yes. However, by using a Network provider you generally ensure your lowest out-of-pocket expense. To find a Network dentist, click here.

How can I get my dentist to join the Network?

Have them call our Provider Services Department at 800.279.4000.

Do my cleanings have to be six months apart?

No. You are allowed two cleanings (prophylaxes) at any time during your Benefit Period (your Benefit Period is listed on your Benefit Summary).

My dentist just told me I will need extensive dental work. What should I do?

First, don't feel pressured to have all the proposed work done immediately. Ask your dentist questions. For example: Why is this needed now? Are there any alternatives? It may help to have an estimate for the proposed treatment sent to us. We can tell you:

• Whether the proposed services are covered by your plan.
• What our reimbursement will be.
• What you will have to pay.

These estimates are not required; however, our members often find them helpful in planning their treatment.

I received my Explanation of Benefits saying I owe $28 for my dental work. Do I pay that to the WEA Trust?

No. Any coinsurance or deductible amounts that appear as your responsibility on an Explanation of Benefits form must be paid directly to the dentist.

My Explanation of Benefits form says I have coinsurance for the dental work I just had done. I don't have any other insurance.

Coinsurance doesn't mean you have other insurance—it refers to a cost-sharing feature of your plan. The percentage that you need to pay is listed on your Benefit Summary, which also describes the services that are subject to coinsurance. Different categories of benefits may have different percentages of coverage. For example, you may have 100% coverage for preventive services but only 80% coverage for fillings.

How does the orthodontic benefit work?

If your plan includes the orthodontic option, we will allow up to one-third of the total treatment as an initial down payment. The remaining two-thirds will be paid in equal quarterly installments over the remaining expected course of treatment. It is customary for the provider to send us the total of the treatment, the cost of the initial downpayment, and the monthly payments.

Why do the Explanation of Benefits you send me for my child's orthodontic work and the bills the orthodontist send me not match up?

This could occur if your provider gave us one set of payment arrangements to pay our liability and provided you with another set of payment arrangements to pay your liability. For example, on a total case of $4,300, we may be reimbursing $1,500 (at a rate of $800 down and $150 per month). The payment arrangements the provider made with you may be based on the remaining $2,800 that is your responsibility.

My daughter is a college student in another state. Can she get dental treatment there?

Yes, as long as she remains an eligible dependent under your plan. It is best to obtain an insurance ID card for your child to take with him or her to college; or at least copies of the front and back of your card. Your child will need to provide the dentist with information from the card. The dentist can call us to verify your child's eligibility for benefits.

Why do I keep getting forms in the mail asking me about other insurance?

Some people are covered by more than one insurance plan. We periodically request updates from you regarding other insurance coverage so we can determine which insurance plan must pay first. When you are covered by more than one plan, one of the plans is primary and the other is secondary. The rules for determining which plan is primary and which plan is secondary are included in Section 10 of your dental policy. Please keep us informed of other dental coverage that you or family members have by either calling us or filling out the forms that we send you.