Understanding Your Benefits
It’s important to understand how your Renaissance plan works in order to take advantage of the benefits available.
Useful information for members who purchased coverage through Healthcare.gov.
It’s much easier to budget for expenses when you know what they are. Renaissance makes it easy for you to find out whether a proposed dental treatment is covered, what amount the plan will pay and the difference you will be responsible for.
What is a pre-treatment estimate?
A pre-treatment estimate is a voluntary, optional procedure where Renaissance issues a written estimate of benefits that may be available under your plan for your proposed dental treatment. Your dentist submits the proposed dental treatment to Renaissance before providing the treatment. This service is free for Renaissance subscribers.
When should I request a pre-treatment estimate from my dentist?
You can request a free pre-treatment estimate at any time. Some specific instances when you may want to request one include:
- If your dentist is recommending extensive treatment
- If you need information on benefit coverage and plan limitations
- If you would like an estimate of how much you may have to pay
How long does it normally take to receive a pre-treatment estimate?
If all information is received with the initial request for pre-treatment estimate, it may take up to 10–14 business days for processing. To receive a pre-treatment estimate even faster, have your dentist submit the request online.
Note: Pre-treatment estimate is provided for informational purposes only and is not required before you receive any dental care. It is not a prerequisite or condition for approval of future dental benefits payment. You will receive the same benefits under your plan whether or not a pre-treatment estimate is requested. The benefits estimate provided on a pre-treatment estimate notice is based on benefits available on the date the notice is issued. A pre-treatment estimate is NOT a guarantee of future dental benefits or payment. When the services are complete, Renaissance will calculate its payment based on your current eligibility, remaining maximum and any deductible requirements.
Availability of benefits at the time your treatment is completed depends on several factors such as, but not limited to, your continued eligibility for benefits, your available annual or lifetime maximum payments, any coordination of benefits, the status of your plan and the dentist, your plan’s limitations and any other plan provisions. A request for a pre-treatment estimate is not a claim for benefits or a preauthorization, precertification or other reservation of future benefits.
Coordination of Benefits (COB) is a procedure for paying health care expenses when people are covered by more than one plan. The goal of COB is to make sure the combined payments of the plans do not exceed the amount of your actual bills.
If you are covered by two or more dental plans—usually because both you and your spouse receive coverage through work—your coverage will be coordinated.
For children covered by both parents’ (or guardians’) dental plans, the primary carrier is determined by the “birthday rule.” The plan that covers the parent or guardian whose birthday comes first in the calendar year will be considered the primary carrier. The birthday rule may be superseded by divorce or court ruling.
If a dependent, such as a spouse or child, has dental coverage through a company other than Renaissance and that company does not cover the full cost of a dental visit or procedure, your dependent may be eligible to receive reimbursement for part or all of the coverage from Renaissance, provided that your dependent is also covered by your plan.
An Explanation of Benefits (EOB) statement is a document that Renaissance may send to you after you receive treatment. This document will explain what procedures were covered under your benefits plan, as well as any procedures that might not have been covered and why they were not covered.
We send the EOB directly to you, and it will provide you with the information you need, including:
- Dental/vision services performed (procedure description)
- Provider fees
- Renaissance’s and/or VSP’s payment
- Your required payment
- Coordination of benefits information, if applicable
- Annual maximums used in the current benefit year
If you have questions about an EOB, please contact us at: 888-358-9484
In-network Benefits—Seeing a dentist in the Renaissance PPO network can help save you money.
The Renaissance PPO network offers members the advantage of even greater savings. When visiting a dentist in the Renaissance network, members have access to these benefits:
- Lower out-of-pocket expenses.
- No paperwork! Your dentist will fill out all forms and file claims for you.
- No extra charges! You’re responsible only for your deductible and/or co-insurance charges.
Finding the right dentist
Finding a participating dentist is easy when you use our Find a Dentist tool. If you contact a dental office directly and they are unfamiliar with Renaissance, please refer to our list of network partners that a dental office will likely recognize:
- Maximum Care
- Connection Dental
- Stratose/4Most (West Virginia employer group members only)
- Premier Dental Group (Minnesota and Wisconsin employer group members only)
- Diversified (Las Vegas, NV employer group members in ZIP codes 890 and 891 only)
Dental Plan Members Insured Through Employer: If you have any questions regarding the participation of a dentist please contact us at 888-358-9484.
Individual Dental Plan Members: You can call us at 888-791-5995 if you’d like help finding a dentist in your area.
Learn more and download our Find a Dentist information
View some of our most commonly asked questions.
These topics provide a general overview and are not specific to any group or individual dental plan. If you need more detailed information, please use our online portals or contact us.