Frequently Asked Questions

The CapDent Plan NY

Q: How many times a year can I have my teeth cleaned?
You can have your teeth cleaned once every 6 months.
Q: What is a pre-existing condition? Is it covered?
A pre-existing condition is any dental or oral health condition, which existed before joining the plan. There are no exclusions for pre-existing dental conditions.
Q: What is work in progess? Is it covered?
Work in progress is dental work that was started prior to joining the plan. The dentist who started the dental work must complete the work. Work in progress is not covered.
Q: Are cosmetic procedures discounted? If so, what procedures?
Cosmetic procedures are not covered.
Q: Is Orthodontia discounted? Is Invisalign braces discounted?
Orthodontia is covered at 25% off the usual and customary fees. Invisalign is not covered.
Q: Do I need to obtain claim forms?
No, you do not need to obtain claim forms.
Q: Is there a waiting period?
No, once your CapDent plan becomes effective you can begin using the plan.
Q: Is this insurance?
Yes, this is an insured Managed Care Dental plan.
Q: Can I change my dentist once I am in the plan?
Yes, you may change to any participating dentist as long as you are not having any major work done at the time.
Q: How do I change my dentist?
Submit your request in writing to Healthplex. Requests received by the 15th will be effective the current month. Requests received after the 15th will be effective the following month. You will receive a new ID card.
Q: My dentist isn't currently in the directory. What can I do?
If your dentist is interested in participating with a managed care program, you can ask Healthplex to send him/her a recruitment package. Applications to participate will be accepted if the dentist meets our credentialing criteria and there is a geographic need for additional providers.
Q: How long does it take to process my application?
Applications are processed by the 20th of each month in order to be effective the 1st of the following month.
Q: When will I receive my enrollment package and what will it include?
Approximately 3 business days after payment is processed , You will receive an email confirmation which will direct you to your Membership Materials. Your ID Card will be mailed in 7 - 10 business days.
Q: If I choose to pay by credit card or Bank Account Draft (ACH) what will my statement read?
Your statement will reflect a charge for "Dental Insurance".
Q: Is the processing fee billed separately or with the plan payment?
The processing fee is billed with the premium.
Q: Do the applicant name and the billing name need to be the same?
No. Payment may be made on behalf of someone else.
Q: What if I need to add or cancel dependents from my benefit plan?
Call when you receive your renewal notice. They will assist you adding or canceling family members and will discuss any premium changes.
Q: If I cancel the policy, will I receive a refund?
When enrolling in this benefit plan, you are agreeing enrollment is on an annual (12 month) basis. After the first 30 days, premium will not be refunded. You may cancel upon renewal.