Spirit Dental – Frequently Asked Questions

Spirit Dental and Vision – Frequently Asked Questions

Is there any age limit?

Currently you must be 18 years of age to be the prime policy holder. Your spouse and unmarried children up to age 26 are also eligible. There is no upper age limit for our policies.

How long will the enrollment process take?

Signing up on line only takes a few minutes. Enrollment materials will be mailed to you within 7-10 days after you apply.

When can I start using my plan?

  • You can start using your plan on your plan on the effective date of your policy.
  • Plan effective date is on either the 1st or the 15th of the month
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    Does my dentist take this plan?

    Spirit PPO (or Network) plans have specific dentists that are part of the Careington Networks.  You can find a list of PPO/Network dentists in your area by visiting the Careington Dental Network website .  The Choose-any-dentist (or Indemnity) plan is a policy that allows you to visit any dentist you choose and you are reimbursed for covered expenses.

    What does choose any dentist mean?

    It means that if you choose the Spirit indemnity dental insurance plan you can keep your own dentist or choose anyone you wish. If you choose a Spirit PPO dental insurance plan you will be able to choose any dentist that you wish that is in the PPO network.

    How much does this dental insurance plan cost per month?

    The monthly price/premium of your dental policy is based on the following five factors:
  • The ZIP code in which you live
  • Your age
  • Coverage type you select: Applicant, Applicant +1, or  Applicant + 2 or more
  • Select Indemnity or PPO provider dental plan
  • Selected calendar-year maximum – $1,200, $2,500, or $3,500.
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    How do I pay for my dental insurance?

    Premiums will be deducted automatically from your bank account on or about the 5th of each month.  Premiums will be deducted automatically from your Credit/Debit Card on the 1st of each month.

    You have the following options:
  • Automatic bank draft from a checking or savings account
  • Visa / Master Card
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    How often do rates change?

    Initial rates are guaranteed for 12 months and can change with 30 days notice after that.

    What will I receive after enrollment?

    An ID card and Policy Certificate of Coverage will be mailed to you.

    I have more dependents than the form allows me to enter?

    Please contact our office by calling 1-800-620-5010 or e-mail carrissa@directbenefits.com for instructions.

    What exactly does no waiting periods mean?

    This is a graduating benefit type of policy which means that there is no waiting period for all the benefits to begin on the policy.

    Does this plan pay 100% coverage after I pay the premium?

    No, it does not, it pays the following:
    Spirit Indemnity Plan
  • Year One – 100% for Preventive Services, 70% for Basic Services, and 10% for Major Services.
  • Year Two – 100% for Preventive Services, 80% for Basic Services, and 50% for Major Services.
  • Year Three – 100% for Preventive Services, 90% of Basic Services, and 50% of Major Services.
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    Spirit Careington PPO Plan
  • Year One – 100% for Preventive Services, 40% for Basic, 20% for Major and 10% for Child Ortho Services.
  • Year Two – 100% for Preventive Services, 80% for Basic Services, 50% for Major and 25% for Child Ortho Services.
  • Year Three – 100% for Preventive Services, 90% for Basic Services , 60% for Major Services, and 50% for Child Ortho Services
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    What does $1,200, $2,500, and $3,500 maximum mean?

    The annual maximum is the dollar amount the insurance company will pay in a calendar year per person.

    Example:  If you receive 3 cleanings and 2 exams the insurance company will pay 100% of the cost which will be around $400.  If in the same year you also need 3 root canals and 3 crowns for a total cost of $4,000, and the insurance company pays $800 of the cost (20% of the cost), the total paid by the insurance company will be $1,200.  If in this situation you had the $1,200 maximum plan, the insurance company will not pay out any more claims in that calendar year and you will out of pocket for any other work.

    What is the deductible and copay of this plan?

  • There are no copays.
  • The Deductible is shown in the Coverage Schedule.
  • The Deductible is an amount of covered dental charges incurred by an insured person for which no benefits will be paid.
  • Deductibles are to a maximum of 3 Individual deductibles per family.*
  • $50/$150 combined Basic/Major annual deductible.
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    How do I know if a procedure will be covered?

    You can refer to the schedule of covered benefits listed on the certificate/policy of insurance.

    Click here to examine a sample certificate/policy

    If I elect to add the Spirit Vision Plan how do I find a participating vision provider?

    Click here to look up Spirit Vision Providers.

    What does PPO mean?

    PPO stands for Preferred Provider Organization.  Also described as a “Network”, PPOs recruit dentists to sign them into the network.  PPO dentists sign an agreement to discount procedures for PPO members, in return they get more customers because they are part of the network.  Since the insurance companies are paying less for procedures they can lower premiums for you.

    What is the difference between the two PPO plans?

    Both PPO’s have the basically the same benefits except for the fact that the Careington PPO covers child orthodontia while the DHA Premier PPO does not.

    Why would I choose a PPO dental plan?

    In addition to paying lower monthly premiums PPO networks enter into contracts with providers to help reduce your out of pocket costs when you visit the dentist. PPO dentists have agreed to accept a standard schedule of pre-determined pricing which is significantly less than the amount you would pay at an out of network dentist for the same procedure.

    What is an Indemnity Dental Insurance plan?

    An indemnity dental insurance plan is often called a traditional dental coverage plan or a fee for service plan. In this type of dental insurance plan, you have the option to visit any dentist or dental care professional you wish. You do not need to select your dentist from a list of network providers or approved providers to qualify for benefits and coverage.

    What does reasonable and customary mean?

    It means the usual, customary and regular charges for the area where such expenses are incurred.

    For Example 90% of Usual and Customary means that 90% of dentists in your area will charge the same or less, only 10% of dentists will charge more

    Features of an Indemnity Dental Insurance Plan

    There are several features of indemnity dental insurance plans for individuals that make these plans different from many other types of dental coverage:

    1. Insurance providers will pay up to 100% of preventive dental care. Typically, this includes regular checkups and cleanings. Many providers will also pay between 50% and 80% of regular and customary dental costs. These costs may include fillings, root canals, and other basic dental work. Check your policy to find out exactly what your plan does and does not cover.

    2. Much of indemnity dental plan insurance benefits center around the term usual and customary. In general, only these treatments are covered by the dental insurance, and as can be expected, what providers consider to be ìusualî and ìcustomaryî varies widely. You will need to read the fine print of the policy your provider sends to find out what is and what is not covered.

    3. There is often a maximum benefit amount for dental benefits with this type of coverage. If you require treatment beyond this limit, you will often be responsible yourself for these costs. It therefore makes sense to find a policy that has a high limit.

    4. These dental insurance plans make use of a UCR (Usual and Customary and Reasonable) fee schedule. These schedules are tables that your dental coverage carrier uses to determine how much to pay you for specific services. These can dramatically affect how much reimbursement you get. For example, if your dentist charges higher fees for services than your dental coverage providers UCR fee schedule indicates is common, then your provider will give you less money for the procedure, leaving you to pay more for the bill.  Spirit Dental pays its UCR (usual and customary and reasonable) based upon the 90th percentile for the area in which you receive treatment.  For example, if 9 out of 10 dentists in your zip code charged $100 cleaning and exam, Spirit would pay $100.  If the dentist charged $102, then Spirit would pay $100 and the dentist could balance bill you for $2.

    What is the 30-day customer satisfaction guarantee?

    All Spirit One-Life Dental and Vision plans come with our 30-day Customer Satisfaction Guarantee. You have 30 days after your plan becomes effective to cancel your plan if you are not satisfied for any reason. Any premium paid (minus the enrollment fee) will be fully refunded provided no covered services have been rendered. If services have been provided, you may still cancel your policy, however, the premium paid will not be eligible for reimbursement.

    When can I cancel my dental insurance policy? Are there any long term contracts?

    You can cancel at any time. All contracts are month to month. There are no long term contracts.

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