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B EST Life is excited to be on 33 state health insurance marketplaces with ACA-certified stand-alone dental plans.

So whether you need dental coverage for child, teen, or even young adult – individuals, families or employer groups of any size – we’ve got you covered. Both on and off the exchange.

When you choose BEST Life, you can rest easy.

Your smiles are safe with us.™
  • 2017 Plans
  • 2016 Plans
  • Additional Information About Your Plan
Out-of-network liability and balance billing

An in-network provider may reduce your cost sharing amount owed (see your schedule of benefits). Also, an in-network provider will not balance bill you for covered service charges that exceed your benefits under this policy. Your policy provides reasonable access to an in-network provider. You can find an in-network provider [here]. You may also contact BEST Life Customer Service at 1-800-433-0088 or at cs@bestlife.com, Monday through Friday, 7 am to 5 pm Pacific Time for assistance. If there is not an in-network provider within fifty (50) miles of your home or workplace, covered services from an out-of-network provider will be paid at the in-network provider benefit levels. Emergency palliative treatment services are also paid at the in-network provider benefit levels.

If you use a provider that is not in-network, they may bill you for all charges that exceed what is covered by your plan, or bill you the balance owed.
Enrollee claims submission

Most often your dentist will submit a claim for you. However, when you need to submit a claim yourself, just follow the simple instructions found on the [dental claim form] or on your ID card. Claims should be submitted within twenty (20) days after a claim starts or as soon as reasonably possible. You can submit claims to cs@bestlife.com, fax them to 208-893-5040 or mail them to:

BEST Life and Health Insurance Company
P.O. Box 890
Meridian, ID 83680-0890

For questions about a claim payment, contact BEST Life’s Customer Service at 800-433-0088 or at cs@bestlife.com, Monday through Friday, 7 am to 5 pm Pacific Time.

Grace periods and claims pending policies

Your policy has a thirty-one (31) day grace period. This means that if a renewal premium is not paid on or before the date it is due, it may be paid during the following thirty-one (31) days. During the grace period, the policy will remain in force and all eligible claims paid according to the terms of your plan. If the required premium is not paid by the end of this grace period, the policy will lapse as of the end of the grace period and any services received after this date will not be paid.

We will reinstate the policy without requiring an application for reinstatement as long as premium is paid for at least the sixty (60) days prior to the date of reinstatement. The reinstated policy will cover only loss resulting from an accidental injury sustained after the date of reinstatement and loss due to sickness beginning ten (10) days after reinstatement. In all other respects the insured shall have the same rights as they had under the policy immediately before the due date of the defaulted premium subject to conditions and provisions of the policy.

If a claim is submitted and additional information is needed from the provider or member receiving the services to determine plan coverage or establish proof of loss, the claim will be pended until the information needed is provided. A claim will also be pended if the date of service is beyond the eligibility date of coverage due to unpaid premium status.

Retroactive denials
If there is an error in an original claim or an error in the services of that claim and the corrected claim services result in a payment which is less than the original claim amount, or denial altogether, we will retroactively deny claims and request previously paid monies to be returned.
Enrollee recoupment of overpayments
Medical necessity and prior authorization timeframes

Your policy covers the least expensive care option that meets professionally recognized care standards. If you choose a more expensive care option when there is a less expensive care option, you are responsible for charges in excess of the less expensive care option. If clinical review criteria are used to determine whether a service is medically necessary, that clinical review criteria may be obtained by contacting us.

Predetermination of services is not required but sometimes recommended. A predetermination is a way for us to let you know how recommended services will be covered until your policy. Services that are not medically necessary or appropriate may not be covered at all.


Predetermination is not proposed for the following:

  • Covered services costing less than $500.
  • Emergency treatment.
  • Oral examinations and cleanings.

Predetermination is suggested for the following services if for children up to 19 years of age:

  • Medically necessary services or supplies.
  • Panoramic film for children under age six.
  • Periodontal scaling and root planning.
  • Occlusal orthotic devices.
  • Applicant therapy.
  • Orthodontia, including preorthodontic treatment visit.

Predetermination is recommended for the following services at any age:

  • Crowns, anterior, except with posts or root canal.
  • Crowns, 2 or more posterior, except with posts or root canal.
  • Inlays or onlays, 2 or more, except with posts or root canal.
  • Laminates.
  • Anterior composites.
  • 2 or more multiple surfaces.
  • Bridges – initial or replacement.
  • Eligible partial dentures – initial or replacement.
  • Periodontal surgery costing more than $500.
  • Full bony impactions, 2 or more.

Upon receipt of a request, we shall complete the predetermination and notify you and your provider. We will have thirty (30) days to send an Explanation of Benefits explaining if the proposed treatment will be a covered service under the policy.

About your Explanation of Benefits (EOBs)

An Explanation of Benefits (EOB) is a statement explaining what medical treatments and/or services were paid for on their behalf. This is sent to an individual once the claim has been adjudicated and payment for coverage has been determined. It shows what the provider charged, what amount was allowed, what amount was paid by your plan and the amount, if any, that you owe to the provider.

Coordination of Benefits (COBs)

The Coordination of Benefits (COB) provision applies when a person has health care coverage under more than one Plan. Plan is defined below.

The order of benefit determination rules govern the order in which each Plan will pay a claim for benefits. The Plan that pays first is called the Primary plan. The Primary plan must pay benefits in accordance with its policy terms without regard to the possibility that another Plan may cover some expenses. The Plan that pays after the Primary plan is the Secondary plan. The Secondary plan may reduce the benefits it pays so that payments from all Plans does not exceed 100 of the total Allowable expense.

Definitions:

  1. Plan: A Plan is any of the following that provides benefits or services for medical or dental care or treatment. If separate contracts are used to provide coordinated coverage for members of a group, the separate contracts are considered parts of the same plan and there is no COB among those separate contracts.

    Plan includes: group insurance contracts, group health maintenance organization (HMO) contracts, group closed panel plans or other forms of group or group-type coverage (whether insured or uninsured); medical care components of group long-term care contracts, such as skilled nursing care; medical benefits under group or individual automobile contracts; and Medicare or any other federal governmental plan, as permitted by law.

    Plan does not include: hospital indemnity coverage or other fixed indemnity coverage; accident only coverage; specified disease or specified accident coverage; limited benefit health coverage, as defined by state law; school accident type coverage; benefits for non-medical components of long-term care policies; Medicare supplement policies; Medicaid policies; coverage under other federal governmental plans, unless permitted by law; or non-group or individual health or medical reimbursement contracts.

    Each contract for coverage under (1) or (2) is a separate Plan. If a Plan has two parts and COB rules apply only to one of the two, each of the parts is treated as a separate Plan.
  2. This plan: This plan means, in a COB provision, the part of the contract providing the health care benefits to which the COB provision applies and which may be reduced because of the benefits of other plans. Any other part of the contract providing health care benefits is separate from this plan. A contract may apply one COB provision to certain benefits, such as dental benefits, coordinating only with similar benefits, and may apply another COB provision to coordinate other benefits.
  3. The Order of Benefit Determination Rules: The Order of Benefit Determination Rules determine whether this plan is a Primary plan or Secondary plan when the person has health care coverage under more than one Plan.

    When this plan is primary, it determines payment for its benefits first before those of any other Plan without considering any other Plan's benefits. When this plan is secondary, it determines its benefits after those of another Plan and may reduce the benefits it pays so that all Plan benefits do not exceed 100 of the total Allowable expense.
  4. Allowable expense: An Allowable expense is a health care expense, including deductibles, coinsurance and copayments, that is covered at least in part by any Plan covering the person. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered an Allowable expense and a benefit paid. An expense that is not covered by any Plan covering the person is not an Allowable expense. In addition, any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an Allowable expense.

    The following are examples of expenses that are not Allowable expenses:
    • The difference between the cost of a semi-private hospital room and a private hospital room is not an Allowable expense, unless one of the Plans provides coverage for private hospital room expenses.
    • If a person is covered by 2 or more Plans that compute their benefit payments on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement methodology, any amount in excess of the highest reimbursement amount for a specific benefit is not an Allowable expense.
    • If a person is covered by 2 or more Plans that provide benefits or services on the basis of negotiated fees, an amount in excess of the highest of the negotiated fees is not an Allowable expense.
    • If a person is covered by one Plan that calculates its benefits or services on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement methodology and another Plan that provides its benefits or services on the basis of negotiated fees, the Primary plan's payment arrangement shall be the Allowable expense for all Plans. However, if the provider has contracted with the Secondary plan to provide the benefit or service for a specific negotiated fee or payment amount that is different than the Primary plan's payment arrangement and if the provider's contract permits, the negotiated fee or payment shall be the Allowable expense used by the Secondary plan to determine its benefits.
    • The amount of any benefit reduction by the Primary plan because a covered person has failed to comply with the Plan provisions is not an Allowable expense. Examples of these types of plan provisions include second surgical opinions, precertification of admissions, and preferred provider arrangements.
  1. Closed panel plan: A Closed panel plan is a Plan that provides health care benefits to covered persons primarily in the form of services through a panel of providers that have contracted with or are employed by the Plan, and that excludes coverage for services provided by other providers, except in cases of emergency or referral by a panel member.
  2. Custodial parent: A custodial parent is the parent awarded custody by a court decree or, in the absence of a court decree, is the parent with whom the child resides more than one half of the calendar year excluding any temporary visitation.


Order of Benefit Determination Rules:

When a person is covered by two or more Plans, the rules for determining the order of benefit payments are as follows:

  1. The Primary plan pays or provides its benefits according to its terms of coverage and without regard to the benefits of under any other Plan.
  2. (1)          Except as provided in Paragraph (2), a Plan that does not contain a coordination of benefits provision that is consistent with this chapter is always primary unless the provisions of both Plans state that the complying plan is primary.
    (2)          Coverage that is obtained by virtue of membership in a group that is designed to supplement a part of a basic package of benefits and provides that this supplementary coverage shall be excess to any other parts of the Plan provided by the contract holder. Examples of these types of situations are major medical coverages that are superimposed over base plan hospital and surgical benefits, and insurance type coverages that are written in connection with a Closed panel plan to provide out-of-network benefits.
  3. A Plan may consider the benefits paid or provided by another Plan in calculating payment of its benefits only when it is secondary to that other Plan.
  4. Each Plan determines its order of benefits using the first of the following rules that apply:
    1. Non-Dependent or Dependent. The Plan that covers the person other than as a dependent, for example as an employee, member, policyholder, subscriber or retiree is the Primary plan and the Plan that covers the person as a dependent is the Secondary plan. However, if the person is a Medicare beneficiary and, as a result of federal law, Medicare is secondary to the Plan covering the person as a dependent; and primary to the Plan covering the person as other than a dependent (e.g. a retired employee); then the order of benefits between the two Plans is reversed so that the Plan covering the person as an employee, member, policyholder, subscriber or retiree is the Secondary plan and the other Plan is the Primary plan.
    2. Dependent Child Covered Under More Than One Plan. Unless there is a court decree stating otherwise, when a dependent child is covered by more than one Plan the order of benefits is determined as follows:
      1. For a dependent child whose parents are married or are living together, whether or not they have ever been married:
        • The Plan of the parent whose birthday falls earlier in the calendar year is the Primary plan; or
        • If both parents have the same birthday, the Plan that has covered the parent the longest is the Primary plan.
      2. For a dependent child whose parents are divorced or separated or not living together, whether or not they have ever been married:
        1. If a court decree states that one of the parents is responsible for the dependent child's health care expenses or health care coverage and the Plan of that parent has actual knowledge of those terms, that Plan is primary. This rule applies to plan years commencing after the Plan is given notice of the court decree;
        2. If a court decree states that both parents are responsible for the dependent child's health care expenses or health care coverage, the provisions of Subparagraph (a) above shall determine the order of benefits;
        3. If a court decree states that the parents have joint custody without specifying that one parent has responsibility for the health care expenses or health care coverage of the dependent child, the provisions of Subparagraph (a) above shall determine the order of benefits; or
        4. If there is no court decree allocating responsibility for the dependent child's health care expenses or health care coverage, the order of benefits for the child are as follows:
          • The Plan covering the Custodial parent;
          • The Plan covering the spouse of the Custodial parent;
          • The Plan covering the non-custodial parent; and then
          • The Plan covering the spouse of the non-custodial parent.
      3. (For a dependent child covered under more than one Plan of individuals who are the parents of the child, the provisions of Subparagraph (a) or (b) above shall determine the order of benefits as if those individuals were the parents of the child.
    3. Active Employee or Retired or Laid-off Employee. The Plan that covers a person as an active employee, that is, an employee who is neither laid off nor retired, is the Primary plan. The Plan covering that same person as a retired or laid-off employee is the Secondary plan. The same would hold true if a person is a dependent of an active employee and that same person is a dependent of a retired or laid-off employee. If the other Plan does not have this rule, and as a result, the Plans do not agree on the order of benefits, this rule is ignored. This rule does not apply if the rule labeled D(l) can determine the order of benefits.
    4. COBRA or State Continuation Coverage. If a person whose coverage is provided pursuant to COBRA or under a right of continuation provided by state or other federal law is covered under another Plan, the Plan covering the person as an employee, member, subscriber or retiree or covering the person as a dependent of an employee, member, subscriber or retiree is the Primary plan and the COBRA or state or other federal continuation coverage is the Secondary plan. If the other Plan does not have this rule, and as a result, the Plans do not agree on the order of benefits, this rule is ignored. This rule does not apply if the rule labeled D (1) can determine the order of benefits.
    5. Longer or Shorter Length of Coverage. The Plan that covered the person as an employee, member, policyholder, subscriber or retiree longer is the Primary plan and the Plan that covered the person the shorter period of time is the Secondary plan.
    6. If the preceding rules do not determine the order of benefits, the Allowable expenses shall be shared equally between the Plans meeting the definition of Plan. In addition, This plan will not pay more than it would have paid had it been the Primary plan.

Effect on The Benefits of This Plan:
A.            When This plan is secondary, it may reduce its benefits so that the total benefits paid or provided by all Plans during a plan year are not more than the total Allowable expenses. In determining the amount to be paid for any claim, the Secondary plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any Allowable expense under its Plan that is unpaid by the Primary plan. The Secondary plan may then reduce its payment by the amount so that, when combined with the amount paid by the Primary plan, the total benefits paid or provided by all Plans for the claim do not exceed the total Allowable expense for that claim. In addition, the Secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage.

B.            If a covered person is enrolled in two or more Closed panel plans and if, for any reason, including the provision of service by a non-panel provider, benefits are not payable by one Closed panel plan, COB shall not apply between that Plan and other Closed panel plans.

Right To Receive And Release Needed Information: Certain facts about health care coverage and services are needed to apply these COB rules and to determine benefits payable under This plan and other Plans. BEST Life may get the facts it needs from or give them to other organizations or persons for the purpose of applying these rules and determining benefits payable under This plan and other Plans covering the person claiming benefits. BEST Life need not tell, or get the consent of, any person to do this. Each person claiming benefits under This plan must give BEST Life any facts it needs to apply those rules and determine benefits payable.

Facility of Payment: A payment made under another Plan may include an amount that should have been paid under This plan. If it does, BEST Life may pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under This plan. BEST Life will not have to pay that amount again. The term "payment made" includes providing benefits in the form of services, in which case "payment made" means the reasonable cash value of the benefits provided in the form of services.

Right of Recovery: If the amount of the payments made by BEST Life is more than it should have paid under this COB provision, it may recover the excess from one or more of the persons it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the covered person. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.