Active Member Dental Benefit
Healthplex Comprehensive
(Dentcare Delivery Systems)
Forms
Co-Payment Listing (.pdf, 539kb)
Change Dentist Form (.pdf, 112b)
Comprehensive Enrollment Form (.pdf, 135b)
Comprehensive Disenrollment Form (.pdf, 71kb)
Adobe Reader is required to view all forms. Download it here
www.adobe.com/products/acrobat/readstep2.htmlOutline of Plan
The Healthplex Comprehensive Plan is a preventative dental program with most services provided with minimal co-payments for prosthetics and anesthesia. The member chooses a conveniently located private dental office from a listing of participating providers. This is the only provider that the member and dependents can visit and any specialty work the primary dentist cannot perform will be referred out to a participating specialist. There is no reimbursement for work not performed by the primary dentist.
Changing Dental Offices
To change dental offices, the member is required to fill out a change of dentist form linked above. This form must be completed and received by the SOC by the 12th of the month for a change in coverage the 1st of the following month.
Please contact the SOC for the most up to date listing of participating providers.
Enrolling/Disenrolling
To enroll or disenroll from Healthplex Comprehensive, the member is required to fill out the corresponding enrollment/disenrollment forms linked above. If a member enrolls or disenrolls from Healthplex Comprehensive, he/she is required to do so for a minimum of one year. If the member is enrolled in Dentall, he/she must disenroll from Dentall to enroll in Healthplex Comprehensive.