What are Essential Health Benefits (EHBs)?
These are a comprehensive set of health benefits determined by the federal government
that must be covered by health plans. Pediatric dental services is one (1) of ten
(10) EHBs. States provided further guidance on what benefits should be part of each
EHB.
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What is a MOOP?
MOOP is the acronym for Maximum Out-of-Pocket. It is also referred to as an Out-of-Pocket
Limit or Out-of-Pocket Maximum. This is the total annual dollar amount that you
are expected to pay before Solstice covers 100% of the Allowed Amount. This applies
only to the pediatric dental EHB.
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Who can enroll in the Pediatric Plan?
The Pediatric Plan was designed with your children in mind. Children up to age 19
may enroll in the plan. We encourage parents to enroll their children on the Pediatric
Plan if they do not elect to purchase benefits for themselves.
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Who can enroll in the Family Plan?
The Family Plan was developed for the entire household. Depending on the state in which you reside,
dependents up to age 25 (AZ EPO), 29 (NY) or 30 (AZ PPO, CO, FL, IL, MI, NJ, OH, PA, TX, VA) may be enrolled in the Family Plan.
The pediatric dental Essential Health Benefit, however, is available only up to age 19.
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Am I able to view your plans, including exclusions and limitations?
Once you have logged into the benefits portal, MySmile365.com, you can view the plan in which you are
currently enrolled, review the plan's exclusions and limitations, and print temporary
ID cards—among other easy tools. Certain limitations are available by viewing our
Schedules.
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How do I obtain a new ID card?
We have made several options for you to obtain your ID card should you lose your
previous one. You may request your ID card by:
- Logging into your benefits portal,
MySmile365.com, and requesting or printing your new ID card
- Contacting our Member Services Department at 1.855.574.1284
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How can I locate a provider in my area?
Under the “Locate a Solstice Provider" section, enter your ZIP code, and plan and
provider type. Once you have entered this information and clicked "Search," you
will be directed to a page with providers in the area you have selected.
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If I have a family policy, do we all have to see the same dentist?
No. Each member of your family can see any participating provider accepting your
plan.
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Do I need to be assigned to a dental office?
Since our plans are open access, you do not need to select a provider. You are free
to see any participating provider within our network that accepts your plan. Simply
call the selected provider for an appointment.
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What is my effective date?
Your effective date is noted on your ID card. If you have not received your ID card,
you may contact our Member Services Department at 1.855.574.1284 to get this
information.
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How often is your website updated with new/terminated providers?
We strive to maintain the most accurate, up-to-date information on our website.
Provider listings are updated on a weekly basis, allowing members faster access
to providers.
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How do I report a concern?
Simply call our Member Services Department at 1.855.574.1284. Our representatives
are available to address any concerns during our regular business hours, which are
Monday-Friday, 8am-6pm.
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What is the difference between EPO and PPO?
EPO stands for Exclusive Provider Organization. If you have an EPO policy, then
it only covers in-network benefits. This means you have to choose a provider from
our directory to receive dental care. Prepaid Limited Health Service Organization,
or PLHSO, policies operate the same way.
PPO stands for Preferred Provider Organization. If you have a PPO policy, then it
covers in-network and out-of-network benefits, but your out-of-pocket costs will
be higher when you receive out-of-network benefits. In-network benefits are the
highest level of coverage available, so you should always consider receiving dental
care first from providers listed in our directory.
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What are appointment availability/access standards?
Providers shall provide an appointment to any eligible member upon request within a reasonable
period of time. In non-emergency situations, such time shall not be more than four (4) weeks after
request. Provider shall also be accessible to provide Emergency Services within a twenty-four (24)
hour period, or within such lesser time as may be medically indicated, any day of the week.
Providers shall arrange for the provision of Covered Services either through their own accessibility or
through a substitute Participating Provider, during normal business hours with the addition of
Emergency Services coverage. Whenever Provider is on vacation or is to be absent for any extended
period of time, Provider shall provide a substitute Participating Provider who shall be responsible for
care and treatment of an eligible member.
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If you have any questions that have not been answered here, please contact our
Member Services Department at 1.855.574.1284.