What is predetermination of benefits?
A test claim sent from the members provider to TDA that shows how TDA will pay on said claim.
How do I contact Total Dental Administrator?
HR should first contact the group’s Account Manager. From there, your manager will assist you in resolving your issue and/or connect you to the proper department.
What are limitation and exclusions?
Limitations and exclusions are procedures not covered by the plan.
Where can I get an Explanation of Benefits (EOB)?
You can easily obtain an Explanation of Benefits by contacting Customer Service. Similarly, you can find your EOB by logging in via your portal on TDAdental.com.
Where can I get a copy of the Benefit Summary?
TDA provides all new groups with a Benefit Summary as part of their Welcome Packet. If you need a new copy, please contact your Account Manager.
When will my coverage take effect once my application is submitted?
Applications received by the TDA office on or before the 18th day of the month will assure benefits begin the first of the following month. All applications received after the 18th of the month will take effect the first of the following full month.
When can I add an employee and how long does it take for this change to go into effect?
New employees can be added during open enrollment, within 30 days of a qualifying event, or after a new hire waiting period. Generally, changes take effect between 7-10 business days.
If my plan is cancelled will I have to pay the administrative fee again?
No. In most cases you would not be required to pay the administrative fee for reinstatement.
Who do I contact with a claims question?
If you have a claims question, please contact your group’s Account Manager or Customer Service.
If we need to send employee information, how do we submit it?
We prefer that if you need to send TDA employee information, you do so via secure email to protect sensitive employee information. You can also fax or mail in the information.
Where do I go with questions about my coverage or plan?
If you have a claims question, please contact Customer Service or your group’s Account Manager.
How do I get reimbursed if I pay my provider out of pocket for services?
You will need to submit a claim to TDA to be paid to yourself. Please fill out the claims form here.
I’m on a DHMO plan; may I change the dentist I selected?
Yes. Simply contact TDA Customer Service with the name of the new dentist. Please also provide the five-digit provider number, which can be found in our Provider Network database. If you need assistance, a Customer Service representative can help you. You may also change the provider on your own via our Change Your DHMO Provider link.
If I want to change dentists, will the current dentist forward my records?
Yes. Your dentist will usually forward pertinent dental records upon request from the new dental office.
What do I do if I need emergency care?
If you are less than 50 miles from your general dentist, you should always attempt to obtain emergency care from your general dentist first. If you are seeking emergency care during normal business hours and your selected general dentist is not accessible, you should contact TDA for assistance at 1(800) 880-3536. If your general dentist is not accessible and you’ve attempted to contact TDA for assistance OR you are more than 50 miles from your general dentist, then you should seek emergency dental care for the relief of pain, bleeding or swelling from any licensed dentist.
How long does it take to get an appointment?
It is not uncommon for a routine exam to be scheduled 4-8 weeks in advance. However, emergency services are always cared for immediately.
Will I get an ID card?
Yes, your membership card will be mailed to you on or before the first day of the month you become eligible. However, you do not need your card to receive care.
How can I get a replacement ID card?
If you know your ID number, login to your Member Portal to request a new ID card. If you do not know your ID number, please contact Customer Service.
Will each member of my family get an ID card?
No, there is one ID card sent to each family. You and/or your dependents do not need an ID card to receive care. If the member insists, we can and will issue a second card as a courtesy.
How much do I pay out of pocket for services?
Out of pocket expenses vary depending on your plan. Please refer to your plan summary for a list of your out of pocket expenses.
Are there benefits for prescription drugs?
There are no traditional benefits for prescription drugs. However, as a value added benefit, we do offer a discount prescription drug card to all TDA members to help alleviate the cost of any prescription drugs you may need.
Can I cover my handicapped dependent child?
Yes, provided that the child is incapable of self-sustaining employment by reason of developmental disability or physical handicap.
My dentist is not on your list, how can he be added?
You may nominate your dentist to join our network via the Nominate a Dentist link. Our Provider Relations team will then contact the dentist to inquire about credentialing with TDA.
Can I cover any family members other than my spouse and children?
The coverage under your plan is limited to your spouse and legally dependent children. Coverage for other family members can be provided through a separate plan.
How does my provider submit a claim and get paid?
Once a member has received treatment, providers will submit a dental claim form to TDA for review. TDA will then submit payment to the provider. If applicable, members are responsible for covering the plan copayment upon time of service.
What is my subscriber ID number?
Your subscriber ID number is your member number; it can be found on your ID card or by contacting Customer Service.
What is the difference between a TDA DHMO plan and a PPO plan?
TDA’s DHMO offers low, predictable payments that allows members to take control of their care. It is not a discount plan, rather a copayment plan. Our PPO plan offers a wider range of dentists, and offers a traditional, coinsurance-based payment plan.
Why do I need to select a dental provider on the DHMO plan?
In efforts to keep fees low, we ask that you select a providper so dentists can anticipate the volume of people coming through their office. Also, by selecting a primary dental provider, dentists will know you’re eligible for care immediately.
Can I go out of network with a DHMO plan?
No, TDA will not offer claim reimbursement for DHMO members that visit non-DHMO participating dentists.
Can I visit a non-participating dentist?
You are free to visit whichever dentist you wish, however, work performed by a dentist that is not part of the TDA network may not be eligible for claim reimbursement.
What dentists can I see with my DHMO plan?
Dentists covered under our DHMO plan can be found via our Provider Network.
How do I register for an account on TDAdental.com?
Does my plan cover out of state benefits?
Some plans cover out of state benefits; please contact your plan administer if you require this benefit.
Which dentists on the list see children?
Many general dentists see children in addition to adult patients. A pedodontist is a specialist that works on children’s teeth. Please refer to your Summary of Benefits to confirm if specialists are covered on your plan.
How can I find a participating dentist in my area?
To find a provider on our networks, visit our website and click on Provider Network.
What are the benefits of visiting a TDA network dentist?
Dentists appointed with TDA offer the largest coverage and reimbursement for members participating in TDA dental plans. TDA is a wholly subsidiary of Blue Cross Blue Shield of South Carolina and provides dental benefits to over 2,000 companies and over 100,000 members. TDA is partnered with other national insurance companies including Best Life Insurance Company, Humana, Companion Life Insurance Company, select Blue Cross companies and more.
Does TDA sell individual plans?
Yes! TDA offers individual dental insurance plans that are standalone and self-paid insurance plans for you and your family. Learn more about individual dental plans here.
What is a copayment?
The copayment, or copay, is the only cost to the member for covered dental services performed.
What is a deductible?
A deductible is the amount you pay for a covered dental care service before your insurance plan starts to pay.
What does MAC mean?
Maximum Allowable Charge, or the same fee that the insurance company would pay in-network for a covered insurance.
What does MPR mean?
Maximum Plan Reimbursement. This means that when you receive out-of-network medical care from a non-participating dentist, there is a limit to the amount of money that will be reimbursed.
What is the difference between DDS and DMD?
DDS and DMD are both a designation as to the degree the dentist received from their dental school. A DDS means a Doctor of Dental Surgery, while a DMD means a Doctor of Medical Dentistry.