Frequently Asked Questions

SmartSmile-WA


Q:
How many times a year can I have my teeth cleaned?
Your SmartSmile plan provides full coverage for two cleanings per year at a low copayment, and a 3rd and 4th at a higher copayment.


Q: What is a pre-existing condition? Is it covered?
Pre-existing condition is a term that refers to any dental or oral health condition (such as a cavity) that existed before you enrolled in your SmartSmile dental plan. Once you have your new dental coverage with Dental Health Services, ALL pre-existing conditions ARE COVERED, if the service needed is a covered benefit.


Q: What is work in progress? Is it covered?
Work in progress refers to dental treatment that is in the process of being completed. Under certain specific circumstances, work in progress is covered under your SmartSmile plan. Under most circumstances, work in progress is not covered.

Q: Are cosmetic procedures covered? If so, what procedures?
No. However, your SmartSmile plan covers some services considered cosmetic such as posterior composite fillings as well as porcelain for molar crowns. Veneers are a covered benefit when deemed necessary by your participating dentist.


Q: Is Orthodontia Covered? What are the Orthodontia benefits?
Yes, orthodontia for both adults and children is covered on your Super SmartSmile (please be sure to change to SmartSmile, when updating Smartsmile page) plan. Orthodontia copayments are based on full banded treatment for up to 24 months.


Q: Do I need to obtain claim forms?
Under almost all circumstances, you DO NOT need to submit any claims to Dental Health Services. Should you experience a dental emergency when you’re out of the participating provider network area, you will need to submit a claim for reimbursement. Your Evidence of Coverage brochure explains the Out-of-Area Emergency procedures in detail.


Q: Is there a waiting period?
Once your SmartSmile plan becomes effective you can begin receiving covered treatment IMMEDIATELY. There are NO waiting periods.


Q: Is this insurance?
Your Dental Health Services SmartSmile Individual Dental Plan is not insurance. Dental Health Services is regulated by the Washington State Insurance Commissioner. SmartSmile is a dental benefit plan.


Q: Can I change my dentist once I am in the plan?
You may change your selected dentist every month while you are covered under the plan by contacting Dental Health Services by the 15th of the month; your change will be made effective the first of the following month.


Q: My dentist isn’t currently in the directory. What can I do?
Dental Health Services consistently seeks high quality dentists to form long-term, successful relationships. If your dentist is not currently listed in the Directory of Participating Dentists, please notify Dental Health Services. Your recommended dentist will be contacted to determine if they are appropriate for the exclusive network of quality assured dentists.


Q: How long does it take to process my application?
Once you submit your completed application, your enrollment will be processed within two business days and made effective the first of the next month.


Q: When will I receive my enrollment package and what will it include?
Your SmartSmile enrollment package will be sent to you within 10 business days. You can expect to receive a copy of your SmartSmile copayment schedule, your Evidence of Coverage brochure and your personal membership card.

Q: If I choose to pay by credit card, what will my credit card statement read?
When paying by credit card, your statement will read “Dental Health Services”.


Q: If I choose to pay by Bank Account Draft (ACH), what will my bank statement read?
The transaction field of your statement will display “Dental Health Services”.


Q: Is the processing fee billed separately or with the premium?
Yes, for your convenience, your one time processing fee is billed separately.

Q: Can I change my payment type once I am in the plan?
Yes! Once you are a SmartSmile member you may change your payment method at any time, simply by contacting your Membership Service Specialist.


Q: If I started with monthly payment, can I change it to annual payment at a later date?
Yes! You may change from the monthly payment option, to an annual payment at any time by contacting your Membership Service Specialist who will be glad to assist you.


Q: Do the applicant name and the billing name need to be the same?
Dental Health Services strives to make your enrollment as easy and flexible as possible. The SmartSmile applicant or enrollee does NOT need to be the same as the person being billed. Simply note on your application that someone other than the applicant will be responsible for the billing, and we’ll note your account to avoid any confusion.


Q: What if I need to change my membership from Individual to Family Coverage?
You may add any eligible family members as dependents to your plan as described in the policies listed in your Evidence of Coverage brochure. Most dependents may be added only during your annual renewal period. Newly acquired dependents (such as from marriage, birth or adoption) may be added within 60 days of the qualifying event.


Q: How do I add or cancel coverage for a dependent?
You may add or cancel a dependent by sending your request in writing, including your signature (either by fax or mail) to Dental Health Services. Please refer to your Evidence of Coverage brochure to determine cancellation effective dates.


Q: If I cancel the policy, will I receive a refund of the premium or processing fee?
If you cancel your membership within your first year of coverage, you will be subject to a $50.00 cancellation fee and will receive a pro-rated refund if applicable. The processing fee is non-refundable.