FREQUENTLY ASKED QUESTIONS

Do I have to choose a dentist?

No. You may select the dentist of your choice. However, you will receive the highest level of benefits available by choosing an in-network provider. When you visit a participating dentist, you have the opportunity to maximize your benefit plan with access to negotiated network fees, resulting in lower out-of-pocket expenses.

What is a negotiated network fee?
A negotiated network fee refers to a discounted schedule that participating in-network providers agree to accept as payment in full for services rendered. Typical discounts range from approximately 20%-50%. Depending on the service rendered, your plan may cover all or part of the discounted fee.

How many dentists are in-network?

There are over 81,000 participating in-network dentists nationwide, including over 15,000 specialists. So, you should be able to locate a participating provider in your area, while traveling, if emergency care is needed, or for your eligible dependents away at college. All in-network dentists meet strict credentialing standards and have agreed to accept negotiated discounts as payment-in-full (no balance billing) for covered services rendered.

How do I locate in-network dentists?

Locate providers by CLICKING HERE.

Do my dependents have to visit the same dentist that I visit?

No, you and your dependent have the freedom to choose any dentist, and can switch as many times as you would like during the policy year.

Who is covered under the Family Plan?

Enrolled members that meet the definition of Family. “Family” means the Eligible Person, spouse and/or domestic partner and Child(ren). “Child” includes natural child, stepchild, foster child, legally adopted child, a child pending finalization of adoption proceedings, and an individual placed in the custody of an Eligible Person as a result of a guardianship or primary care. ‘Primary care’ means that the Eligible Person provides food, clothing, and shelter, on a regular and continuous basis, for the minor grandchild, niece or nephew during the time that schools are in regular session. “Eligible Child” means any unmarried Child(ren) of the Eligible Person until the end of the calendar month which he/she reaches age 21; or until the end of the calendar month which he/she reaches age 23 if a full-time student (written proof is required).

How do I get reimbursed if I visit an out-of-network dentist?

If you visit a dentist out-of-network, you are responsible for paying the entire amount of the dentist’s usual and customary charge (non-discounted rate) at the time of service. You must then submit a claim form so that we may process your claim, determine the Maximum Allowable Charge and determine if any reimbursement is payable for the claim.  How and when do I file a claim? In-network provides have contractually agreed to file claims for you. If your dentist does not participate in the network (out-of-network), you may have to file the claim yourself. A claim form is included in your welcome kit, it is also available from your benefits administrator.  Remember to bring a claim form with you to your appointment so your dentist can help you fill it out. For each claim submission, GDS will expeditiously mail you a concise explanation of benefits and reimbursement according to your plan guidelines. For questions regarding dental benefits or claims, please call: 1-800-650-6601.

Where should I mail my claim?

GDS – Claims Department

PO Box 10949

Rockville, MD 20849