Provider FAQs

Some members may have dental-only coverage. In these cases:

• The eligibility screen may display inactive medical coverage
• However, the member may still have active dental benefits

What this means for providers:

• In NaviNet^®, review both:
  • Eligibility and Benefits
  • Schedule of Benefits (SOB)
• Do not rely solely on the medical coverage status shown on the initial screen

Dental SOB documents outline benefit structure, such as:

• Covered services
• Deductibles and maximums
• Waiting period requirements

These documents may not include a member-specific effective date.

What this means for providers:

• The SOB reflects plan design, not individual eligibility details
• To confirm effective dates and waiting periods:
  
  • Use NaviNet Eligibility and Benefits, or
  • Contact Provider Services

Waiting period language in the SOB describes standard plan rules.

Because effective dates are not included in the SOB:

• It may not show whether waiting periods have been satisfied

Recommended approach:

• Use NaviNet to verify:
  
  • Member eligibility
  • Coverage effective dates
• Contact Provider Services if additional confirmation is needed

For certain plans, such as Medicare Supplement plans with embedded dental benefits:

• The eligibility screen may display medical coverage only
• Dental coverage may not be clearly shown on the initial view

What this means for providers:

• Dental benefits may still be available
• Review the SOB in NaviNet to confirm available dental coverage

In some cases:

• The SOB may reflect subscriber-level dental benefits
• This information may display even when dependents are not enrolled

What this means for providers:

• The presence of an SOB does not confirm dependent eligibility
• In NaviNet, confirm eligibility at the individual member level

No. If an effective date appears on the SOB, it typically reflects:

• The date the dental plan option became available to the group

It does not represent the member’s individual effective date.

What this means for providers:

• Use NaviNet Eligibility and Benefits to confirm:
  • Member-specific effective dates
• Contact Provider Services if clarification is needed

To support accurate claims and reduce delays:

Use NaviNet to:

• Verify member-specific eligibility
• Confirm:
  • Coverage status
  • Effective dates
  • Waiting period applicability
• Review the SOB when needed

If additional support is needed:

• Contact Provider Services for assistance