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Individual Select Dental HMO

Individual Select - Dental HMO offers coverage of routine dental services and major dental procedures at predictable costs.

 

 

 

 

 

 

 

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Overview

Individual Select Dental HMO


Selected Benefits At-a-Glance

The Individual Select - Dental HMO (DHMO) plan offers the following advantages:

  • A network of more than 580 dental providers throughout Maryland, DC, and Northern Virginia
  • Dental coverage includes:
    • Preventive care including cleanings, examinations, and X-rays
    • Basic services including fillings and extractions
    • Major surgical services including oral surgery and root canal therapy
    • Major restorative services including dentures, fixed bridges, and crowns
    • Orthodontia coverage for chldren and adults
  • Predictable out-of-pocket costs for covered dental services
  • No annual deductibles to meet
  • No claim forms to file
  • No annual and lifetime benefit maximums
  • No waiting periods
How the Plan Works

The plan is designed to be cost-effective, easy to use, and predictable. There are no claims for you to file and you know what your out-of-pocket costs will be before you go to the dentist!

When you enroll, you will receive a membership card and a detailed information packet. You will need to select a participating primary care dental provider as part of your enrollment.

When you need care, just call your primary care dental provider and make an appointment. Be sure to take your card with you! At your primary care dental provider's office, pay the copay for services received. The dentist will submit all the necessary forms.

If you have questions or need assistance, call us at 410-847-9060 or 888-833-8464.

Select Level of Coverage and a Dentist

Select a Coverage Level and Designate a Payment Option

The Dental Network offers Individual Select - Dental HMO, a dental managed care plan to residents of Maryland, D.C., and parts of Northern Virginia1. You must agree to remain in the plan for at least one year.

Type of Plan
Annual Cost
Semi Annual Cost*
Individual $120 $65
Parent/Child $204 $107
Subscriber/Spouse $240 $125
Family $360 $185

* Includes a $5 administrative fee.

Coverage for Dependent Children

Dependent children are covered up to age 26.

Payment Options

Pay for your plan annually or semi-annually.

  • Annual:  Pay the full amount of the annual cost when you submit the enrollment application.
  • Semi-annual (2 payments):  Include the first semi-annual payment when you submit the enrollment application. You will receive a bill for the second payment due on the first of the seventh month from the effective date of coverage.

1 Our service area includes the cities of Alexandria and Fairfax, the town of Vienna, Arlington County and the areas of Fairfax and Prince William counties in Virginia lying east of Route 123.


Select a Primary Care Dentist

 

Find a Provider in our network.

 

Note: If you visit a dental provider that does not participate in your plan, you will pay the full cost and will not be reimbursed.

Apply To Enroll

Complete the Appropriate Enrollment Application and Send it to Us with Payment

Enrollment Applications:

Download and complete the application. Choose the annual or semi-annual payment option.

Send in your application, with a check or money order for the exact payment amount of the premium to:

Mail Administrator
P.O. Box 79810
Baltimore, MD
21279-0810

Please Note: You must live in Maryland, the District of Columbia or the following areas of Northern Virginia: the city of Alexandria or Fairfax, the town of Vienna, Arlington County, or the areas of Fairfax and Prince William counties in Virginia lying east of Route 123.

We will mail you your membership card and a detailed information packet. Your coverage will be effective the first of the month following receipt of application and premium, if received by the 20th of the month.

Plan Resources

Use the links below to review your dental benefits and related costs and access the appropriate application: 

Maryland
District of Columbia
Virginia
Individual Select Plan Comparison Chart Individual Select Plan Comparison Chart Individual Select Plan Comparison Chart
Brochure/Application Brochure/Application Brochure/Application

You may also find a provider in our network and get answers to frequently asked questions:

Contact Us
For Questions About:
Contact Us At:
Mailing Address:
Customer Service
  • Members and Providers
  • Membership Verification
  • Plan and Benefit Questions
  • Claims Questions
  • Primary Care Dentists Inquiries
  • Membership Card Requests
Telephone:
(410) 847-9060 or (888) 833-8464

E-Mail:
TDNService@CareFirst.com

Hours:
Monday - Friday 8:30 am - 5:00 pm
N/A

Claims

Telephone:
(410) 847-9060 or (888) 833-8464

Hours:
Monday - Friday 8:30 am - 5:00 pm
Mail Administrators
PO Box 14118
Lexington, KY 40512-4118

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