Vision & Dental FAQs
Q1. How can I verify my plan’s coverage?
A1. There are two ways: First, you can call customer service (Vision Customer Service 866-425-2323 or Dental Customer Service 800-501-3471) and they will provide you with your specific plan information. Second, your provider can call our provider service line to verify your vision or dental care plan coverage.
Q2. Do Advantica’s Dental and Vision Benefit Plans offer out-of-network benefits?
A2. Many of Advantica’s Dental and Vision Benefit Plans do offer out-of-network benefits. Refer to your benefit booklet for additional information regarding your plan’s out-of-network benefits. Note that not all plans have out-of-network benefits, so please contact your benefits administrator or call our customer service center (Vision Customer Service 866-425-2323 or Dental Customer Service 800-501-3471) for assistance.
Q3. How will I be covered for out-of-network visits?
A3. If you visit an out-of-network provider you will need to submit an out-of-network reimbursement form for payment, with a copy of the original receipt, to the following address:
Attention: Claims Department
PO Box 8510
St. Louis, MO 63126
Fax: 314.849.4830 or 800.501.8432
Q4. What if no network providers are available to me?
A4. If you believe there are no network providers available in your area, please contact Advantica for assistance. We may be able to help you find a network provider who is accessible to you. If Advantica determines that no in-network providers are available to you and you obtain care from an out-of-network provider, Advantica will reimburse your claim as if you received care from an in-network provider. If you contact Advantica in advance and obtain approval by Advantica to receive out-of-network services at the in-network level, Advantica will adjudicate your claims accordingly. If you do not contact Advantica in advance you may submit an appeal and your claim will be adjusted if Advantica determines no network providers were available.
Coverage - Vision
Q1. Am I limited to a certain selection of eyeglass frames?
A1. No. If you do not find an eyeglass frame that suits your preference, you may choose a frame outside the plan allowance and pay the provider the overage.
Q2. Can I choose contact lenses instead of eyeglasses?
A2. Yes, you can use your benefits to purchase contact lenses in lieu of eyeglasses (subject to plan frequency and co-pay, please refer to your ID card for further information).
Q3. Do Advantica’s vision plans cover LASIK surgery?
A3. LASIK is not a covered benefit with Advantica. However, as a member you are entitled to preferred pricing with our affiliated Laser Vision Surgery provider, QualSight.
Coverage - Dental
Q1. Is routine care covered?
A1. Generally, routine periodic exams, cleanings (prophylaxis) and bitewing radiographs are covered, but limited to two (2) visits during a 12 month consecutive period and separated by an interval of six (6) months. Preventive services beyond these frequencies are the patient's responsibility. Please refer to your account information for specific details regarding your benefits.
Q2. Until what age are my dependents covered under my policy?
A2. Each employer group varies. Please refer to your account for information regarding dependent age limits, full-time student status or handicap qualifications.
Q3. What's the difference between participating network providers and non-participating providers who accept Advantica Dental Benefits' plans?
A3. Participating network providers are contracted with Advantica Dental Benefits and offer discounted fees. Non-participating providers who accept Advantica Dental Benefits plans are not contracted and could bill you for fees exceeding the maximum allowable charge.
Q4. Does it cost significantly more to visit non-participating, out-of-network provider?
A4. Your cost will depend on the price charges for dental services. You may be billed for fees exceeding the maximum allowable charge. You may also be responsible for paying the provider prior to receiving services.
Q1. Will I ever have to pay out of pocket?
A1. Certain dental procedures, lens options, or frames priced beyond the allowance, may require an out-of-pocket payment.
Q2. Will I have a copayment when I visit my provider?
A2. Advantica’s plans sometimes require copayments, please refer to your vision or dental benefit plan outline for more information on your plan’s coverages.
Q3: What is a copayment or co-pay?
A3. A copayment is a one-time payment that is made during a visit.
Q1. Do I need to fill out a claim form before I receive services?
A1. No. As an Advantica member, you do not need to submit a claim form before you receive care. The provider will verify eligibility as well as submit a claim for payment. You are only responsible for any applicable copayments.
Q2. How do I verify my eligibility and benefits?
A2. There are two ways to verify eligibility with Advantica. First, you can call customer service (Vision Customer Service 866-425-2323 or Dental Customer Service 800-501-3471) and they will provide you with eligibility information. Second, your provider can call our eligibility line to verify your eligibility.
Q3. How can I find an Advantica Provider?
A3. A current list of Advantica Vision and Dental Providers can be found online using the Provider Search tool.
Q1. Will I receive an ID card?
A1. Yes. All Advantica Members receive an ID card by mail. Please allow sufficient time for your card to arrive, if you do not receive one, or need a replacement, please send a message to our support team.
Q2. Will Advantica use my Social Security number for my ID card?
A2. At Advantica, we take pride in safeguarding our members’ private information. Social Security numbers are kept in members’ secured files only, and are not displayed on ID cards. Each vision benefit plan group is given a unique group number, and each member is given a unique ID number.
Q3. What is my member ID number?
A3. Advantica assigns you a member number that will be located on your ID card.
Q4. How can I get a new ID card?
A4. To obtain a new ID card, please contact an Advantica representative (Vision Customer Service 866-425-2323 or Dental Customer Service 800-501-3471), or send a request to our support team via email at firstname.lastname@example.org.
Q5. What if I have to go to the doctor and don’t have my ID card?
A5. Make your appointment and upon arrival tell your provider that you do not have a card. They will then ask for your name, Social Security number, and date of birth. With this information they will be able to determine your eligibility.