Finding/Selecting a Dentist

How do I find a participating provider?

For a complete listing of participating dentists, please visit DominionNational.com/teethkeepersdentists.

For a complete listing of participating vision providers, please visit DominionNational.com/find-vision-provider.

Can each family member select a different participating dental office?

Yes, each family member in the program may choose a different dentist or dental office.

Select Plan subscribers are required to select a participating dentist prior to receiving coverage, but may select a different dentist or dental office for each family member in the program by going online or calling Customer Service at 888.518.5338.

ePPO and Discount Program subscribers must use a participating network dentist, but are not required to select a dentist. Each family member in the program may also receive care from different participating dentists and dental offices.

PPO subscribers and their family members in the program may receive dental care from any licensed dentist and are not required to select a dentist. However, members should always consider using a participating network dentist to maximize their out-of-pocket savings. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

Can a member change dentists for any reason?

Select Plan subscribers are required to select a participating dentist prior to receiving coverage. If a Select Plan member wants to change his or her dentist or dental office, he or she may do so at any time by emailing through the online contact form or calling Customer Service at 888.518.5338. If notification is received by Dominion on or before the 20th of the month, the change will be effective on the first of the following month. All outstanding bills with the current dental office MUST be paid before the change will be made effective.

ePPO and Discount Program members must use a participating network dentist, but may change dentists at any time.

PPO members may receive their dental care from any licensed dentist and may change dentists at any time. Members should always consider using a participating network dentist to maximize their out-of-pocket savings. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

Are additional dentists being recruited?

One of our primary goals is to provide you with the best possible access to participating dentists. We have designated staff whose sole responsibility is to develop our dental networks and we are continually adding new dentists. For the most up-to-date listing, visit DominionNational.com/teethkeepersdentists. To request that your dentist be contacted about joining our networks, please click here.

Claims Submission

Where do I submit dental claims?

Benefits will be paid to you or they may be assigned directly to your dentist. Your dentist may use the standard American Dental Association claims form. Claims can be filed electronically, faxed to 833.517.1939 or mailed to:

Dominion National
P.O. Box 211424
Eagan, MN 55121
Fax: 833.517.1939

Where can I find a claim form?

Click here for an ADA Claim Form.

Where do I submit vision claims?

It is the responsibility of the provider to submit your claim for in-network services. If you utilize out-of-network services, it is your responsibility to pay the provider in full at the time of service and then submit your claim and itemized receipts to NVA for reimbursement. Claims must be mailed to:

NVA Claims Department
P.O. Box 2187
Clifton, NJ 07015-2187

Coverage, Benefits & Services

How do I know if a service is covered under my dental program?

Select Plan members should refer to their Description of Benefits and Member Copayments for information on covered benefits. Discount Program members should refer to their Description of Services and Member Fees. PPO and ePPO members should refer to their Coverage Schedule for information on covered benefits. Make sure you carefully review the exclusions and frequency limitations listed in the document.

What information will I receive when I enroll?

You will be sent ID cards and additional information that explains the program in detail by email and/or mail.

What is a deductible?

The annual amount each member must pay for dental services before the plan will begin to cover the member’s dental procedures. If dependents are covered, there may be a family deductible, which is the overall limit on what a family will pay before the dental plan pays. Pediatric plans may also have separate deductibles.

What is an annual or lifetime maximum?

The maximum dollar amount that the plan will pay toward the cost of dental services within the specified period per member. Maximum is shared for in-network and out-of-network services (if covered).

What is an out-of-pocket maximum?

The maximum dollar amount that the member will pay toward the cost of covered pediatric dental services within the specified period per child.

What is coinsurance?

The percentage of a covered dental service cost paid by insurance (as listed in the PPO Coverage Schedule).

What is balance billing?

Out-of-network PPO dentists set their own fees, of which your insurance plan may only pay a portion (if covered). Balance billing occurs when the out-of-network dentist’s fee is higher than the insurance plan’s reimbursement fee to the dentist and the member is billed the remaining balance to cover the additional costs. Always consider using a participating network dentist to maximize your out-of-pocket savings. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

What is your dependent age policy?

Adult plans cover dependents up to age 26 unless otherwise specified in your Individual Dental Policy. Pediatric plans cover dependents under the age of 19 (coverage continues through the end of the month in which the member turns 19) unless otherwise specified in your Individual Dental Policy.

How do I arrange for specialty care?

Select Plan, ePPO and Discount Program members should get a referral from their general dentist. The dentist will evaluate your condition and refer you to a participating specialist as needed.

PPO members may receive services from any licensed dentist, including specialists, without a referral from a general dentist. For maximum benefits at the lowest cost, members should visit a participating Dominion dentist. To learn more about in-network savings, visit DominionNational.com/EOB and select “In-Network Advantages” in the PPO section.

Below are some examples and descriptions of various dental specialists.

• Endodontist: Treats the roots and nerves of teeth.
• Oral Surgeon: Treats problems related to the hard and soft tissues of the face, mouth and jaws.
• Orthodontist: Treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures.
• Pediatric dentist: Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist.
• Periodontist: Treats diseases of the supporting and surrounding tissues of the teeth.
• Prosthodontist: Restores natural teeth and replaces missing teeth with artificial substitutes.

What happens if a family member or I has an emergency?

Select Plan subscribers are required to select a participating dentist and ePPO subscribers must use a participating network dentist. If a Select Plan or ePPO member is temporarily more than 50 miles away from home and requires emergency treatment for the care of an injury, toothache or accident, they may seek treatment from any dentist. Dominion will reimburse the member up to $100 (unlimited in the states of NJ and PA; and VA for pediatric only plans) for palliative treatment after submitting copies of their receipt to Dominion. Any member copayments that apply under the member’s plan will be deducted from the amount of the claim.

PPO subscribers may receive emergency dental services from any licensed dentist and file a claim as normal.

The Discount Program provides discounts only on services provided by a participating dentist and does not provide any special discounts on emergency services.

Please see your plan documents for full terms and conditions.

Do you cover pre-existing conditions?

The Select Plan covers most pre-existing conditions, including coverage for missing teeth. PPO Plans may have certain restrictions, which are best described in the pre-enrollment brochure, Coverage Schedule and other distributed materials.

The Discount Program has no pre-existing conditions.

Contact Information and Online Resources

What are your hours of operation?

Service Team Associates are available from 7:30 a.m. to 6:00 p.m. Eastern, Monday through Friday, at 888.518.5338. After business hours, members have access to certain functions via our Interactive Voice Response (IVR) system.

You may also access your account 24/7 on Dominion’s secure member portal at DominionMembers.com and the MyDominion mobile website at DominionNational.com/mobile.

Chat with us!

You can access us during regular business hours via the online chat feature. To access this convenient and personalized way of communication with us, click on the icon at the bottom right of the screen.

Does Dominion have online resource available to me?

Yes, Dominion understands that each of our customers is unique and has different communication preferences so we’ve created a variety of online tools to provide you with instant access to your account whenever and wherever you need it. To ensure you always have access to real-time benefit information, we encourage you to sign up for the below online resources where you may view your digital ID card, find a provider and more.

Member Portal
DominionMembers.com

Go Mobile Communication Service
Register by calling 888.596.0716.