The Florida Conference dental plan terminated as of 12/31/2011. Members may file claims for expenses that were incurred in 2011. Claims must be filed with WEB-TPA by March 31, 2012. Reimubursements will not be paid out after this date. You may use the claim form below or your dentist may file your claims for you.
The Florida Conference dental insurance plan is a IRS Section 125 pre-tax benefit plan administered by WEB-TPA Employer Services. It is important to note that once you enroll in this plan, you cannot terminate your enrollment unless there is an IRS approved “change in status” event (such as a marriage, birth, death, etc…). If you choose to cancel coverage during the plan year (without a permitted change-in-status) you are still responsible for the monthly premium for the remainder of the calendar year.
About Your Plan
This new plan will work much like the former CompBenefits indemnity plan in that you can choose any dental provider. There is no network of dentists that you have to use to receive reimbursement under this plan.
Reimbursement under the plan is based on Usual & Customary (U&C) fees after you satisfy the deductible. The plan will pay claims based upon the U&C fee allowance (also called Reasonable and Customary fee). The U&C fee is defined as the charge for dental care that is consistent with the average rate or charge for identical or similar services in a certain geographical area.
When the dental plan disallows a portion of a charge as being in excess of the U&C fee, it means only that the charge is in excess of the standard rate used to determine U&C fees. Providers are free to charge whatever fee for service they choose. Your insurance coverage is designed to provide benefits up to the plan’s U&C fee and is priced accordingly.
However, many dentists will not accept U&C fees as payment in full. In the event the dentist will not accept the plan reimbursement as payment in full - you are responsible for the difference between the amount the plan pays and the provider’s full charge.
We recommend that you ask your dentist to submit a “pre-treatment estimate” to WEB-TPA for services estimated at $100 or more prior to receiving services. This will provide you and your dentist with the amount of reimbursement from the plan.
Ask your dentist if they will accept U&C fees when you inquire about services. You can negotiate with providers over any anticipated remaining balance – if you discuss this in advance of treatment being provided.
Remember, your coinsurance amount is calculated after the U&C fee is determined. Because this plan does not use a designated provider network with negotiated fees, you may be responsible for the difference between the U&C fee and the provider’s charge. If your dental provider agrees to accept the U&C fee as payment in full – you will not have any further responsibility.