Frequently Asked Questions

The Frequently Asked Questions are updated regularly to help you find answers to some of the important questions you may have regarding the program. 

Dental Wellness Plan Kids Transition (Member and Provider Questions)

This document answers the following questions: 

• What is happening?
• When will this happen?
• Who does this affect?
• Who will administer the children's Medicaid dental benefits?
• Does this affect the Hawki program?
• Does this affect the I-Smile program at all?
• Will the children's dental benefit be changing as part of this transition?
• Will the fee schedule for providers change as part of this transition?
• Will children now be subject to an annual benefit maximum as adults enrolled in the Dental Wellness Plan are?
• Will there be an annual or monthly premium?
• Will children be required to complete Healthy Behaviors?
• If a dentist is enrolled enrolled with Iowa Medicaid, do they still need to enroll with Delta Dental or MCNA if they want to see Medicaid children?
• Why did IME decide to move children to managed care?
• What does this transition mean for providers?
• Will the benefit change when children transition to dental benefit administrators?
• How will member be made aware of this change to their dental benefit?
• Will members be informed if their current dentist is not enrolled with MCNA or DDIA?
• Can providers choose which dental plan administrator(s) to participate with?
• Can providers limit the number of members they accept into their practice? Can providers only accept adults or children or must they now accept all members?
• Will existing FFS prior authorizations be honored by the dental plan administrators?
• Will claims be honored if a member receives services by a provider not enrolled in the dental plan the member is assigned to?
• Are training sessions scheduled for providers to learn more about this transition and ask questions?
• How will providers check a member's eligibility and plan assignment?

Dental Wellness Plan Background Information

This document answers the following questions:

• What is the Dental Wellness Plan?
• What is Dental Wellness Plan Kids?
• Will I still receive Iowa Medicaid dental coverage before I transition to a dental carrier?
• Who is included in the Dental Wellness Plan/Dental Wellness Plan Kids?
• Who is excluded from the Dental Wellness Plan?
• My child is on Hawki, will they be enrolled in the Dental Wellness Plan program?
• My child is Fee-for-Service (FFS), will they be enrolled in the Dental Wellness Plan program?
• I have a senior dental plan. What is the difference between a senior dental plan and the Dental Wellness Plan?
• What's new for 2018? (Effective September 1, 2018)

Dental Wellness Enrollment

This document answers the following questions:

• I received an enrollment packet/ enrollment letter, what do I need to do now?
• Why does it say that I've already been assigned to a dental carrier?
• How do I know which dental carrier is best for me?
• What is my 'Choice Period End Date'?
• How do I turn in my dental carrier choice?
• What are the dates for making a dental carrier change?
• When will my dental carrier change take effect?
• What if I don't make a change by my Choice Period End Date but I want to later?
• What happens if I don't choose a dental carrier?
• Will I get a new ID card?
• When will I receive an ID card from my dental carrier?

Annual Choice Period

This document answers the following questions:

• Do I have to change my dental carrier?
• Do the dental carriers offer different benefits?
• How do I know which dental carrier is right for me?
• How long do I have to change my dental carrier?
• What if I don't change my dental carrier now but I want to later?
• What is a "Good Cause" reason?
• How do I change my dental carrier?
• Will I still receive dental benefits before I start coverage with my new dental carrier?
• Will my benefits change?
• Will I get a new ID card?
• I have an upcoming appointment, which card do I use?
• If I change dental carriers, can I keep my current provider?
• If I change my dental carrier and my provider is not in their network, will my visit still be covered or will I have to pay out-of-pocket?

Benefits and Services

This document answers the following questions:

• What are my dental benefits?
• How do I know if a service is covered or not?
• Do I have a copay?
• Is there an annual benefit limit?
• What dental services count toward my annual benefit limit?
• What dental services do not count toward my annual benefit limit?
• What if I reach my benefit limit for the year, can I still receive dental services?
• How will I know if I have reached my annual benefit limit?
• Can I receive Non-Emergency Medical Transportation (NEMT) for my upcoming dentist appointment?
• How do I arrange a ride for a dental appointment?
• If a member has a Prior Authorization for services, will it be honored by the dental carriers? If so, how long will it be honored?

Providers

• Is my provider in my dental carrier's provider network?
• My current dental provider is not in my dental carrier's network, can I continue to see my dentist?
• What if I choose a dental carrier and my provider chooses a different dental carrier? Will my visit still be covered or will I have to pay out-of-pocket?
• If a Dental Wellness Plan member sees a provider who is a registered Fee-for-Service (FFS) provider with IME, but not signed with any dental carrier and not willing to work with the dental carriers, will the state pay?
• Can I be billed from providers who are not participating with Medicaid or the dental carriers?

Resources

• How do I contact the dental carriers?
• Where can I find important documents?