Broker FAQs
Employer FAQs
Member FAQs
Broker FAQs
How does a Broker get a quote?
For groups up to 50 employees, please select the appropriate link below to obtain the portfolio of available plans and rates. For 3rd Quarter effective dates (7/1/10-9/30/10) click here. For 4th Quarter effective dates (10/1/10-12/31/10) click here. You will need:
- Employer Group Size
- Employer Group Zip Code
- SIC Code
- Employer Contribution %
- Whether or not group had prior dental coverage
For groups with more than 50 employees, please contact your Coventry Account Manager or call Broker Services. You will need:
- Group Census (to include gender, date of birth, home Zip Code and selected dental coverage for each eligible employee)
- Employer Group Zip Code
- SIC Code
- Employer Contribution %
- Whether or not group had prior dental coverage
You must be a licensed agent, appointed by Coventry Health and Life, to sell a Coventry Dental product.
What is a Contributory plan?
Contributory plans are those where the Employer pays at least 50% of the premiums (the employee would pay the remaining portion) and at least 75% of eligible employees enroll in the plan (50% including spousal waivers). Premiums for Contributory plans are lower than for non-Contributory or “Voluntary” plans.
What is a Voluntary plan?
Voluntary (or “non-Contributory”) plans are those where the Employee pays for at least 50% of the premiums or less than 75% of eligible employees enroll in the plan (less than 50% including spousal waivers). Premiums for Voluntary plans are higher than for Contributory plans.
What is a Virgin plan?
A Virgin plan is offered to Employer Groups that have not had prior dental coverage.
What is a Maximum Allowable Charge?
For certain plans, Coventry Dental pays out-of-network benefits up to a Maximum Allowable Charge (or “MAC”). Coverage for Covered Services provided by Out-of-Network Providers is limited to the MAC amount, which is what we would have paid a Network Provider in the same geographic area, less the applicable Out-of-Network Copayment, Deductible and/or Coinsurance amounts the member is required to pay under the plan.
What documents does a Broker need to submit a sold group?
Please submit a completed and signed Group Application, Member Dental Enrollment Forms, and proof of prior coverage (such as invoice from prior carrier).
How long does it take for a new group to be installed?
We will have your group installed and ID cards mailed within 7-10 business days of receipt of your materials.
How and when are commissions paid to a Broker?
You must be the Broker of Record for a Group to receive commissions. Commissions are paid each month based on premiums paid for the prior month. If you are the Broker of Record for a group with a Coventry Medical plan, your dental commissions will be included on your Coventry Medical commission statement.
Employer FAQs
How does an Employer get a quote?
For detailed plan designs and to obtain a quote, contact your Insurance Agent/Broker or call Employer Services.
How many dentists are in the Coventry Dental PPO network?
We have more than 105,000 dentists and dental offices in our network throughout the country.
When will an Employer Group receive the Group Policy and Certificate of Coverage?
A copy of the Group Policy and Certificate of Coverage will be included with the Administration Kit and e-mailed to the Group’s Plan Administrator within 10 business days of Coventry Dental receiving your group’s installation documents.
How does an Employer Group notify Coventry Dental of a changes to the Group’s company name or address?
Changes to the Group’s company name or address should be directed to your Coventry Account Manager or Employer Services..
How does an Employer Group submit a Broker of Record change?
The Group must send a letter to the Coventry Account Manager indicating the new broker and the effective date of the change.
How does the Employer Group manage their account online?
If you are the plan administrator of an Employer Group with a Coventry Dental plan, you should have received instructions and a customized link to register on this site. This link is sent during the initial group installation process from newgroup@cvtydental.com. After you have registered, you can log in at any time. Note: The plan administrator must register before the group’s members will be able to log in to manage their accounts.
By registering and logging in to your account, a plan administrator will have access to:
• Manage Eligibility - Submit enrollment applications; add/term dependents; terminate coverage; change personal information such as address, and change benefit plan (only during open enrollment)
• View Documents – The policy, certificate, enrollment form, claim form, and admin manual are available in the document section
• View Roster – You can view a report of all active members in the system. (Please note that this report only shows people active today. People who are active tomorrow will not show until tomorrow).
How does the Employer Group enroll a new employee or terminate/change coverage for an existing enrollee?
The plan administrator for the Employer Group can log in to their account and manage employee eligibility online.
When should an Employer Group expect to receive an invoice?
Invoices are mailed by the 15th of each month for the following month’s coverage. Payment is due by the 1st of the month of coverage.
Member FAQs
What is a PPO plan?
A “PPO” is a Preferred Provider Organization. It is a benefits plan where members have the flexibility of visiting any licensed dentist, but typically save more by visiting a dentist who participates in the PPO network.
What is an Indemnity plan?
An Indemnity plan is a more traditional insurance plan where you have the flexibility to visit any licensed dentist. There is no dental network. Typically your costs in an Indemnity plan will be more than in a PPO plan.
What is DenteMax?
Since 1985, DenteMax has been building and managing a quality, national, credentialed dental PPO network which today has more than 105,000 access points. DenteMax provides the network of dentists for Coventry Dental PPO plans.
When will I receive my Dental ID card?
Your ID card will be mailed to your home approximately 7 – 10 business days after Coventry Dental receives your enrollment.
What if I lost my ID card?
You do not need an ID card in order to visit a dentist. However, if you need a replacement card, you can contact Member Services.
How do I log into my member account?
If you are enrolled in a Coventry Dental plan, please select the Member log in and enter the Group Number and Member ID located on your ID card. You will need to select a username and password. You will be able to:
• Update your name, address, and other coverage information
• Check on your claim status
• Download your Certificate of Coverage
Note: Your group’s plan administrator must register before the group’s members will be able to log in to manage their accounts.
What do I do if I forgot my password?
Please contact Member Services and a Customer Service Representative will reset your password.
Where should I submit claims?
Please submit claims to:
Coventry Dental
PO Box 7402
London, KY 40742
Providers can submit claims electronically using EMDEON. Our Payor ID is CX049.
Who will receive payment for the claims?
Payment will be sent to the provider or member based on the assignment of benefits listed on the submitted claim form.
How long does it take to have a claim processed?
Most claims will be processed within 10 business days.
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