Dental Frequency Limitations and Commonly Asked Questions
Network
We utilize the Connection Dental/PPO USA network. Connection Dental Dentist Search. Currently, the only plans we offer that have out of network benefits are CW-Dental-01 and PL-Standard-Dental-01.
Orthodontia is not a covered benefit unless the member has a CW-Dental-01 or PL-Standard-Dental-01 plan which will cover 25% up to a $1,000.00 lifetime limit. We pay on the date we receive the claim and not monthly, quarterly, or yearly.
Plan Outlines
Dental Frequency Limitations
- Oral examinations are covered once in any 6-month period
- Routine cleanings are covered once in any 6-month period
- Periodontal cleanings are covered once in any 6-month period (do not share frequencies with oral exams or routine cleanings)
- Topical fluoride up to age 16 – covered once in any 12-month period
- Diagnostic x-rays, full or panoramic – covered once in any 36-month period
- Bitewing x-rays – covered once in any 6-month period
- Sealant – covered once in any 12-month period, 14 and younger (permanent molars only, no decay)
- Prosthetic Replacements (crown, dentures) – covered once per tooth in any 60-month period
- Night guard – covered once in any 36-month period (bruxism only)
- Full Mouth Debridement – covered once in any 24-month period
- SRP (Scaling and Root Planing) - covered once in any 12-month period
Frequently Asked Questions
- Do you have a missing tooth clause? No
- Do emergency or problem focused oral evaluations count towards the routine and oral exam limits? No
- Do you downgrade to amalgam? No
- Are bone grafts covered? No
- For COB, is it standard or non-duplicate? Standard
- Do you pay on the prep or seat date? The seat date
- Are there any waiting periods? No
- Is orthodontia covered? Yes, at 25% up to a $1,000.00 lifetime limit
- Where do I mail claims? The fastest way to get your claim processed is by submitting it through our EDI Payer ID: 65241
Claim Mailing Address:
Planstin
PO Box 21747
Eagan, MN 55121