We have compiled a list of the most frequently asked questions made to our Group Billing and Group Services Representatives. We hope this information will help you.
When are premiums due?
Invoices are generated one month in advance of the coverage month and are due by the 20th of the invoice month.
For example: An invoice for the month of September is generated on August 1st. The premium for September is due no later than August 20th.
How do we cancel an employee's coverage?
There are two ways to cancel an employee's coverage:
A. You can write down the pertinent information regarding that employee and fax the request to Billing & Eligibility at (949) 389-9751. We will then issue a credit on the next invoice. (This method is the most expedient.)
B. Another option is to put a line through the employee's name on the invoice and indicate "delete' on the same line. Adjust the remitted premium or we will issue a credit on the next month's invoice. Be sure to indicate termination date.
How do we add a member?
Simply place the new member's name and premium amount on the statement. Be sure to include the new member's enrollment form and premium with your group invoice and payment. The new member's effective date will be the first of the following month, provided payment is received no later than the 20th of the preceding month. If the additional premium for the new member is not included with the enrollment form, the subsequent group invoice will include the premium due for that member.
What happens if we forget to send the premium with the enrollment form?
Your subsequent monthly group statement will include the premium due for that member.
It's after the 20th of the month and we've already sent in our payment. Is it too late to add or delete employees?
You can add or delete employees and their dependents through the last day of the month prior to the coverage month.
However, the change will not be reflected on the next statement. In case of an emergency, an employee may be added at any time.
We just received our new invoice and the employees that were added or deleted last month are not reflected on the invoice.
Although your invoice is dated on the first, it was generated on the 20th of the previous month. Any changes that were received after the 20th of the month will appear on the following month's invoice. Nothing more needs to be done.
When I fax an enrollment form to SmileSaver, do I need to send the original enrollment form in the mail?
No. All we need is the faxed enrollment form. Sending the original may cause duplication, which can result in double billing.
Can our employees select a provider after they've enrolled?
Yes. Simply have them call our Member Services Department at (800) 880-1800 with their provider selection.
Can an employee change providers?
Yes. If an employee wants to change providers, we request that they call our Member Services Department before the 20th of the current month for the provider change to be effective on the 1st of the following month.
How long should a member wait for a non-emergency appointment?
As a general guideline, appointments for routine primary (non-emergency) care should be available within two weeks, but not more than three weeks. Hygiene (cleaning) appointments should be available within four to six weeks. Longer waiting times may occur for appointments in heavily demanded time slots (after school, early morning, etc.). Availability is determined by the dental provider, not SmileSaver, and varies from office to office.
Emergency appointments should be scheduled within 24 hours, but in no case longer than medically advisable.
Will our employees be charged sterilization fees?
A sterilization fee is a charge that is used by some offices to offset part of the costs of the infection control procedures utilized by the individual facility. Sometimes this fee is referred to as an OSHA fee, an infection control fee, a sterilization fee or an operatory (room) set-up fee. This fee is not a covered benefit and the amount will vary from office to office.
What do we do if we are dissatisfied with a provider, a dental or vision office, or treatment?
If an employee is dissatisfied with any aspect of service from a provider, the employee may file either an oral or written complaint with SmileSaver. Please call our Member Services Department for assistance.
Do you have any reference materials in Spanish?
Yes. Please call your Group Services Representative at (800) 880-1800 to request Spanish materials.
How do we cancel our group plan?
The group must provide SmileSaver with a written notice of cancellation a minimum of 30 days prior to the desired cancellation date. The cancellation will become effective the first day of the following month.
What if I want to change my broker?
A group may request that a different broker be assigned to their account. All requests must be in writing from the group and addressed to the Agent Services Department with all pertinent information to process the broker change. These changes need to be submitted before the 20th of the month to take effect the 1st of the following month.
What if I have questions or need help?
For service questions regarding the following topics, please contact your Group Services Representative at (800) 880-1800, 24 hours, 7 days a week.
- Member additions and deletions
- Eligibility verification
- Plan and ID card information
- Questions pertaining to providers or benefits
- Supply requests
- Billing questions
Please note: To ensure proper credit, be sure to include your group number on all correspondence and, particularly, on checks.