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Forms and documents

2025 Individual Plan Documents

Medicare Advantage Plans

Forms

Reimbursement schedules for participating dental providers are available through Availity Essentials: Payer Spaces > Resources.

Transparency in Coverage

The transparency in coverage section of this website is intended to provide general information concerning our plans and aid in understanding common dental insurance concepts. Please refer to your policy for specific details about what is covered in your plan.

To learn more about the topics listed below, please visit our transparency in coverage page.

Explanation of Benefits (EOBs)

Out of Network Liability and Balance Billing

Enrollee Claims Submission

Grace periods and claim pending policies

Retroactive claim denials

Enrollee recoupment of premium overpayments

Medical necessity, prior authorization timeframes, and enrollee responsibilities

Coordination of benefits (COB)

How to Avoid Retroactive Terminations