Forms
Change Forms
Individual Plan Change Form
Miscellaneous
Helpful Benefit Hints - Information to help you get
the most out of your dental plan.
ACE Privacy Policy in Spanish
ACE Privacy Policy
Dental Claim Form
Authorization Form
Automatic Bank Withdrawal Form
FAQ's for Members on an
Individual and Family Plan
When will my monthly
premium be drafted from my account?
Co-pay and Co-insurance
plans
Your account will be drafted on
or around the 16th of each month for the following
month's premium. If you enroll on the plan
after the 15th of the month, two(2) month's premiums
will be drafted from your account on or around the
16th of the following month to include the current
month and the following month's premiums.
Thereafter, you will only be drafted for one month's
premium on or around the 16th of the month.
Discount Plan
Forms
Change Forms
Individual Plan Change Form
Miscellaneous
Helpful Benefit Hints - Information to help you get
the most out of your dental plan.
ACE Privacy Policy in Spanish
ACE Privacy Policy
Dental Claim Form
Authorization Form
Individual Bank Draft Form
FAQ's
When will my monthly
premium be drafted from my account?
Forms
Change Forms
Individual Plan Change Form
Miscellaneous
Helpful Benefit Hints - Information to help you get
the most out of your dental plan.
ACE Privacy Policy in Spanish
ACE Privacy Policy
Dental Claim Form
Authorization Form
Individual Bank Draft Form
FAQ's for Members on an
Individual and Family Plan
When will my monthly
premium be drafted from my account?
Co-pay and Co-insurance
plans
Your account will be drafted on
or around the 16th of each month for the following
month's premium. If you enroll on the plan
after the 15th of the month, two(2) month's premiums
will be drafted from your account on or around the
16th of the following month to include the current
month and the following month's premiums.
Thereafter, you will only be drafted for one month's
premium on or around the 16th of the month.
Discount Plan
Your account will be drafted on
or around the 16th of the month. If you enroll on
the plan after the 15th of the month, two(2) month's
premiums will be drafted from your account on or
around the 16th of the following month to include
the previous month and the current month's premiums.
Thereafter, you will only be drafted for one month's
premiums on or around the 16th of the month.
When will I be able to
use my benefits? Waiting periods are
determined by your plan contract.
-
Discount Plan - Discounts
are available the day you enroll
-
Co-Pay and Co-Insurance Plans
- Some benefits are subject to waiting
periods, however, you are eligible from your
effective date for discounted fees when
visiting a network provider. Please refer
to your summary of benefits included in your
ID card booklet.
If I upgrade to a
different plan, will my waiting periods start over?
Specific waiting period rules apply when switching
plans. Please contact Dental Select member
services at 1-800-999-9789 for details.
I want to cancel my
Individual/Family coverage. What form do I
need to submit? You must submit a written
request to cancel by letter, fax or email.
Please send all cancellation requests to:
Dental Select
Attn: Eligibility
Department
5373 S. Green Street, Suite 400
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email:
idp@dentalselect.com
The banking information
for my Individual/Family plan has changed.
What is the best way to get that information to
Dental Select? Submit an Individual Plan
Bank Draft Form. This form can be found under
the Forms section of this page. Mail or fax
the completed form to:
Dental Select
Attn: Eligibility
Department
5373 S. Green Street, Suite 400
Salt Lake City, UT 84123
Fax: (888) 998-8706
On a Co-Insurance -
Platinum Network Plan, what is the maximum on Major
services after my waiting periods are met?
There is a $1,000 annual maximum, of which $500 can
be used for Major services.
Change Forms
Individual Plan Change Form
Miscellaneous
Helpful Benefit Hints - Information to help you get
the most out of your dental plan.
ACE Privacy Policy in Spanish
ACE Privacy Policy
Dental Claim Form
Authorization Form
Automatic Bank Withdrawal Form
FAQ's for Members on an
Individual and Family Plan
When will my monthly
premium be drafted from my account?
Co-pay and Co-insurance
plans
Your account will be drafted on
or around the 16th of each month for the following
month's premium. If you enroll on the plan
after the 15th of the month, two(2) month's premiums
will be drafted from your account on or around the
16th of the following month to include the current
month and the following month's premiums.
Thereafter, you will only be drafted for one month's
premium on or around the 16th of the month.
Discount Plan
Your account will be drafted on
or around the 16th of the month. If you enroll on
the plan after the 15th of the month, two(2) month's
premiums will be drafted from your account on or
around the 16th of the following month to include
the previous month and the current month's premiums.
Thereafter, you will only be drafted for one month's
premiums on or around the 16th of the month.
When will I be able to
use my benefits? Waiting periods are
determined by your plan contract.
-
Discount Plan - Discounts
are available the day you enroll
-
Co-Pay and Co-Insurance Plans
- Some benefits are subject to waiting
periods, however, you are eligible from your
effective date for discounted fees when
visiting a network provider. Please refer
to your summary of benefits included in your
ID card booklet.
If I upgrade to a
different plan, will my waiting periods start over?
Specific waiting period rules apply when switching
plans. Please contact Dental Select member
services at 1-800-999-9789 for details.
I want to cancel my
Individual/Family coverage. What form do I
need to submit? You must submit a written
request to cancel by letter, fax or email.
Please send all cancellation requests to:
Dental Select
Attn: Eligibility
Department
5373 S. Green Street, Suite 400
Salt Lake City, UT, 84123
Fax: (888) 998-8711
Email:
idp@dentalselect.com
The banking information
for my Individual/Family plan has changed.
What is the best way to get that information to
Dental Select? Submit an Individual Plan
Bank Draft Form. This form can be found under
the Forms section of this page. Mail or fax
the completed form to:
Dental Select
Attn: Eligibility
Department
5373 S. Green Street, Suite 400
Salt Lake City, UT 84123
Fax: (888) 998-8706
On a Co-Insurance -
Platinum Network Plan, what is the maximum on Major
services after my waiting periods are met?
There is a $1,000 annual maximum, of which $500 can
be used for Major services.
What are my
benefits if I choose to see a specialist
rather than a general practicioner?
This varies according to your plan:
-
Co-pay Plan Specialists:
You receive 20% off the in-network
specialists' fee for covered services.
Discount only - no benefit will be paid.
There is no payment from Dental Select for
specialist services.
-
Co-Insurance Plans: In
network specialists - you receive 20% off
the Specialist fee for covered services.
You are responsible for the difference
between the plan payment and the discounted
Specialist's fee. For services from all
Out-of-Network Specialists, you are
responsible for charges exceeding the plan
payment.
Can minor children be
the primary subscriber on an insured plan?
Minor children are not legally
responsible to make a valid contract, therefore they
cannot be the primary subscriber on an insured plan.
On a Co-Insurance -
Platinum Network Plan, what is the maximum on Major
services after my waiting periods are met?
There is a $1,000 annual maximum, of which $500 can
be used for Major services.
What are my
benefits if I choose to see a specialist
rather than a general practicioner?
This varies according to your plan:
-
Co-pay Plan Specialists:
You receive 20% off the in-network
specialists' fee for covered services.
Discount only - no benefit will be paid.
Excludes Pediatric Specialist on the Gold
Network. For Gold Network Co-pay plan
pediatric specialist benefits, refer to
schedule of co-payments.
-
Co-Insurance Plans: In
network specialists - you receive 20% off
the Specialist fee for covered services.
You are responsible for the difference
between the plan payment and the discounted
Specialist's fee. For services from all
Out-of-Network Specialists, you are
responsible for charges exceeding the plan
payment.
Can minor children be
the primary subscriber on an insured plan?
Minor children are not legally
responsible to make a valid contract, therefore they
cannot be the primary subscriber on an insured plan.