FLORIDA

MEDICAID
DENTAL HEALTH
PROGRAM
ENROLLEE HANDBOOK
SEPTEMBER 2019
INTERPRETATION AND TRANSLATION SERVICES NON-DISCRIMINATION NOTICE
DentaQuest complies with applicable Federal civil rights laws and does not
If you need interpretation/translation services, discriminate on the basis of race, color, national origin, age, disability, sex,
please call 888-468-5509, TTY 800-466-7566. gender identity or sexual orientation. DentaQuest does not exclude people or
treat them differently because of race, color, national origin, age, disability, sex,
We can provide a translator for you over the gender identity or sexual orientation.
phone. If you have a hard time with hearing or DentaQuest:
speech, please call us at TTY 800-466-7566. • Provides free aids and services to people with disabilities to
communicate effectively with us, such as:
You have the right to materials and information, • Qualified sign language interpreters
including this handbook in: • Written information in other formats (large print, audio, and
accessible electronic formats)
• Audio • Provides free language services to people whose primary language is
not English, such as:
• Braille • Qualified interpreters
• Larger print • Information written in other languages
If you need these services, click here for member services numbers listed by
• Other languages state and plan.

Call DentaQuest member services at If you believe that DentaQuest has failed to provide these services or
discriminated in another way on the basis of race, color, national origin, age,
888-468-5509, TTY 800-466-7566, disability, or sex, you can file a grievance with:
8 am to 7 pm for these materials. Ugonna Onyekwu
Civil Rights Coordinator
Compliance Department
465 Medford Street
Boston, MA 02159
Fax: 617-886-1390
Phone: 617-886-1683
Email: [email protected]
TTY: 711

You can file a grievance in person or by mail, fax, or email. If you need help
filing a grievance, Ugonna Onyekwu is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health
and Human Services, Office for Civil Rights. Complaint forms are available at IMPORTANT CONTACT INFORMATION
www.hhs.gov/ocr/office/file/index.html. You can file a complaint electronically
through the Office for Civil Rights Complaint Portal, available at You can contact Where Times
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: 888-468-5509 Available
Member Help Line TTY
U.S. Department of Health and Human Services TTY 800-466-7566 24 hours
200 Independence Avenue, SW Available
Room 509F, HHH Building Website www.DentaQuest.com/Florida
24 hours
Washington, D.C. 20201
www.DentaQuest.com/Florida
1-800-368-1019, 800-537-7697 (TDD)
• “Find-A-Provider” on webpage.
If you do not speak English, call us at 888-468-5509, TTY 800-466-7566. • Select Florida
We have access to interpreter services and can help answer your questions in • Select your plan <plan name> Available
your language. We can also help you find a health care provider who can talk Find-A-Dentist • You can search for providers 24 hours
with you in your language. using your home or work
Si usted no habla inglés, llámenos al 888-468-5509, TTY 800-466-7566. address. You can also search
Ofrecemos servicios de interpretación y podemos ayudarle a responder for a provider who offers
preguntas en su idioma. También podemos ayudarle a encontrar un proveedor special care.
de salud que pueda comunicarse con usted en su idioma. 11100 W. Liberty Drive Monday-Friday
Office Address
Si vous ne parlez pas anglais, appelez-nous au 888-468-5509, Milwaukee, WI 53224 8 a.m. to 7 p.m.
TTY 800-466-7566. Nous avons accès à des services d'interprétariat pour Office Telephone 888-468-5509 Monday-Friday
vous aider à répondre aux questions dans votre langue. Nous pouvons Number TTY 800-466-7566 8 a.m. to 7 p.m.
également vous aider à trouver un prestataire de soins de santé qui peut
communiquer avec vous dans votre langue.
Si ou pa pale lang Anglè, rele nou nan888-468-5509, TTY 800-466-7566.
Nou ka jwenn sèvis entèprèt pou ou, epitou nou kapab ede reponn kesyon ou
yo nan lang ou pale a. Nou kapab ede ou jwenn yon pwofesyonèl swen sante
ki kapab kominike avèk ou nan lang ou pale a.
Se non parli inglese chiamaci al 888-468-5509, TTY 800-466-7566.
Disponiamo di servizi di interpretariato e siamo in grado di rispondere alle tue
domande nella tua lingua. Possiamo anche aiutarti a trovare un fornitore di
servizi sanitari che parli la tua lingua.
Если вы не разговариваете по-английски, позвоните нам по
номеру 888-468-5509, TTY 800-466-7566. У нас есть возможность
воспользоваться услугами переводчика, и мы поможем вам получить
ответы на вопросы на вашем родном языке. Кроме того, мы можем
оказать вам помощь в поиске поставщика медицинских услуг,
который может общаться с вами на вашем родном языке.
Member Helpline 888-468-5509
TABLE OF CONTENTS
Member Help Line TTY 800-466-7566
To report suspected Welcome to DentaQuest's Dental Health Plan ...........................................................................1
1-800-96-ABUSE (1-800-962-2873)
cases of abuse, neglect, Dental Home .................................................................................................................................................................1
TTY: 711 or 1-800-955-8771
abandonment, or Section 1: Your Dental Plan Identification Card (ID Card) ..............................................2
exploitation of children or http://www.myflfamilies.com/service-programs/
Section 2: Your Privacy .....................................................................................................................................2
vulnerable adults abuse-hotline
Section 3: Getting Help from Member Services .......................................................................6
1-866-762-2237 Section 4: Do You Need Help Communicating? ......................................................................6
TTY: 711 or 1-800-955-8771 Section 5: When Your Information Changes ................................................................................7
For Medicaid Eligibility http://www.myflfamilies.com/service-programs/ Section 6: Your Medicaid Eligibility .......................................................................................................7
access-florida-food-medical-assistance-cash/ Section 7: Enrollment in Our Plan ...........................................................................................................8
medicaid Section 8: Leaving Our Plan (Disenrollment) ..............................................................................9
To report Medicaid Fraud 1-888-419-3456 Section 9: Managing Your Care ................................................................................................................10
and/or Abuse or to file a Section 10: Accessing Services .................................................................................................................10
complaint about a health https://apps.ahca.myflorida.com/mpi-
complaintform/ Section 11: Helpful Information About Your Benefits ...........................................................13
care facility
Section 12: Your Plan Benefits: Dental Services .......................................................................18
1-877-254-1055 Section 13: Member Satisfaction .............................................................................................................23
To file a complaint about
TDD: 1-866-467-4970 Section 14: Your Enrollee Rights................................................................................................................27
Medicaid services
http://ahca.myflorida.com/Medicaid/complaints Section 15: Your Enrollee Responsibilities ......................................................................................28
1-877-254-1055 Section 16: Other Important Information .........................................................................................29
To request a Medicaid Fair Section 17: Additional Resources ............................................................................................................30
1-239-338-2642 (fax)
Hearing Member Healthy Behavior Incentive Form .....................................................................................32
[email protected]
Risk Assessment Form .......................................................................................................................................33
To find information about
888-468-5509, TTY 800-466-7566 Contact Information Update Form ..........................................................................................................36
urgent care- after hours
9-1-1
For an emergency
Or go to the nearest emergency room

Contact your Health Plan if you have questions about your medical
benefits.

You can find your Health Plan information here:

https://ahca.myflorida.com/medicaid/statewide_mc/pdf/mma/SMMC_
Provider_Plan_Contacts_2018-08-06.pdf
WELCOME TO DENTAQUEST’S
DENTAL HEALTH PLAN
DentaQuest has a contract with the Florida Agency for Health Care
Administration to provide dental services to people with Medicaid. This is
called the Florida Dental Health Program (DHP). You are enrolled in our
dental health plan. This means that we will offer you Medicaid dental services.
We work with a group of dental providers to help meet your dental needs.

This handbook will be your guide for all dental services available to you. You
can ask us any questions, or get help making appointments. If you need to
speak with us, just call us at 888-468-5509, TTY 800-466-7566.

DENTAL HOME
Each person in your family who has dental benefits through this program is
assigned a Dental Home. A Dental Home is a dentist your household sees
every six month. The dentist at your Dental Home will provide the care your
family needs to stay healthy.

Your household’s Dental Home was chosen by looking for:

• The dental office of your last dental visit or

• The dental office of a brother or sister’s last dental visit or
• The dental office close to your home zip code
Call DentaQuest if you have questions about your Dental Home. You can also
call if you would like to change your household’s Dental Home. DentaQuest
member services 888-468-5509, TTY: 800-466-7566.

1
 Section 1 Member Privacy
YOUR DENTAL PLAN IDENTIFICATION CARD DentaQuest takes your privacy seriously. We want to tell you about our privacy
practices to protect your personal health information.
(ID CARD)
How Do We Use Health Information?
You should have received your dental ID card in the mail. Call us if you have
DentaQuest uses and discloses your health information to facilitate your
not received your card or if the information on your card is wrong. Each
treatment, coordinate payment for treatment, and for other related health care
member of your family in our plan should have their own dental ID card.
operations. Examples of these uses and disclosures include:
Carry your dental ID card at all times and show it each time you go to a dental
• Treatment: DentaQuest discloses your health information to dentists
appointment. Never give your dental ID card to anyone else to use. If your
who are providing treatment to you or coordinating care with another
dental ID card is lost or stolen, call us so we can give you a new dental ID card.
dentist, such as a specialist, for the purposes of facilitating your
Your dental ID card will look like this: treatment. For example, we may discuss your treatment plan with your
dentist.
• Payment: DentaQuest uses and discloses your health information for
payment purposes. For example, we pay claims submitted by dentists
who provide treatment to you.
• Health Care Operations: DentaQuest discloses your health information
for health care operations in the normal course of our business. For
example, we may use or disclose your information for purposes of
underwriting, enrollment, and other activities related to creating,
renewing, or replacing a benefits plan. We may not, however, use or
disclose genetic information for underwriting purposes.
We comply with all applicable state and federal laws, including any laws that
impact our ability to use your health information for payment and operations.
Section 2
Other Services:
YOUR PRIVACY
DentaQuest may also use or disclose your health information for other
Your privacy is important to us. You have rights when it comes to protecting
reasons. These include uses and disclosures that are:
your health information, such as your name, Plan identification number, race,
ethnicity, and other things that identify you. We will not share any health • Required by law, including pursuant to a court order or to health
information about you that is not allowed by law. oversight agencies or law enforcement agencies.
If you have any questions, call Member Services. Our privacy policies and • For public health activities or to coroners and medical examiners in the
protections are: event of death.
• For communications with family or friends or a legal guardian involved
DentaQuest Privacy Notice
in your care or who is authorized by you or by law.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS • To your employer (or other plan sponsor) for administration of the plan
INFORMATION. PLEASE REVIEW IT CAREFULLY. (unless you are covered by an individual policy).
• For workers compensation, as permitted by law.
2 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 3
 Except as described in this notice, we may not use or disclose your • Provide you with notice of our legal duties and a description of our
information without your written authorization. You may give us written privacy practices with respect to your protected health information;
authorization to use your protected health information or to disclose it to and
anyone for any purpose. If you give us written authorization, you may revoke • Notify affected parties of a breach of unsecured protected health
it at any time by notifying us of your revocation in writing. Your revocation will information.
not affect any use or disclosure permitted by the authorization while it was
in effect. We need your written authorization to sell information about you to • Notify Texas residents that their protected health information is
a third party or, in most circumstances, to use or disclose your information subject to electronic disclosure.
to send you communications about products and services. We do not need DentaQuest is obligated to provide this notice to you and abide by the terms
your written authorization, however, to send you communications about of the notice currently in effect. We reserve the right to change privacy
health related products or services, as long as the products or services are practices and make new practices effective for all the information we maintain.
associated with your coverage or are offered by us. We will notify you of a material change to our privacy notice. Revised notices
will be available to you at our website www.DentaQuest.com/Florida and, upon
Your Right to Protection of Your Health Information request, we will mail a revised notice to you.
Below is a list of your rights with respect to your protected health information.
You may exercise any of these rights by contacting the Privacy Officer using Contacting Us, Comments, Suggestions, or Complaints
the contact information listed below. If you would like to contact us regarding a claim or coverage, please contact
us by
• You have the right to request restrictions on certain uses and
disclosures of protected health information. Please be aware that e-mail: [email protected]
DentaQuest is not required to agree to the requested restriction. phone: 800-334-6277
• You have the right to receive communications of protected health or mail:
information from DentaQuest at an alternative address or using DentaQuest
alternative means (i.e., e-mail), provided that disclosure of all or part of Attn: Member Services
the information using the current delivery method could not endanger P.O. Box 2906
you. Milwaukee, WI 53201-2906
• You have the right to see or obtain a copy of the protected health If you want to exercise your privacy rights, feel your privacy rights have been
information that we maintain about you in a designated record set violated, or if you need more information, contact our Privacy Officer by e-mail:
(certain fees may apply). [email protected] , phone 888-788-8600 or mail:
• You have the right to amend the protected health information that
we maintain about you in a designated record set if it is incorrect or DentaQuest
outdated. Attn: Privacy Officer
P.O. Box 2906
• You have the right to request a paper copy of this notice Milwaukee, WI 53201-2906
DentaQuest's Obligations to Protect Your Health Information:
As your dental insurance company or the administrator of your dental All complaints will be investigated and you will not suffer retaliation for filing a
benefits, DentaQuest is required by law and by its contractual obligations to: complaint. You may also file a complaint regarding health information with the
Secretary of Health and Human Services in Washington, D.C.
• Maintain the privacy of your health information;

4 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 5

 Section 3 • Help in making or getting to appointments
GETTING HELP FROM MEMBER SERVICES • Names and addresses of providers who specialize in your disability
Our Member Services Department can answer all of your questions. We can All of these services are provided free to you.
help you choose or change your Primary Dental Provider (PDP for short), find
out if a service is covered, get referrals, find a provider, replace a lost ID card,
and explain any changes that might affect you or your family’s benefits. Section 5
Contacting Member Services WHEN YOUR INFORMATION CHANGES
You may call us at 888-468-5509, TTY 800-466-7566 Monday to Friday,
If any of your personal information changes, let us know as soon as possible.
8 am to 7 pm, but not on State approved holidays (like Christmas Day and
You can do so by calling Member Services. We need to be able to reach you
Thanksgiving Day). When you call, make sure you have your identification
about your health care needs.
card (ID card) with you so we can help you. (If you lose your ID card, or if
it is stolen, call Member Services.) The Department of Children and Families (DCF) needs to know when your
name, address, county, or telephone number changes as well. Call DCF toll free
Special needs: If you have special needs that DentaQuest or your PDP
at 1-866-762-2237 (TTY 1-800-955-8771) Monday through Friday from 8 a.m.
need to know about, please contact Member Services. We can help!
to 5:30 p.m. You can also go online and make the changes in your Automated
Contacting Member Services after Hours Community Connection to Economic Self Sufficiency (ACCESS) account at
If you call when we are closed, please leave a message. We will call you https://dcf-access.dcf.state.fl.us/access/index.do.
back the next business day. If you have an urgent question, you may call
You may also contact the Social Security Administration (SSA) to report
our 24-7 enrollee services line at 888-468-5509, TTY 800-466-7566. Our
changes. Call SSA toll free at 1-800-772-1213 (TTY 1-800-325-0778), Monday
nurses are available to help you 24 hours a day, 7 days a week.
through Friday from 7 a.m. to 7 p.m. You may also contact your local Social
Security office or go online and make changes in your my Social Security
account at https://secure.ssa.gov/RIL/SiView.do.
Section 4
DO YOU NEED HELP COMMUNICATING?
If you do not speak English, we can help. We have people who help us talk to Section 6
you in your language. We provide this help for free. YOUR MEDICAID ELIGIBILITY
For people with disabilities: If you use a wheelchair, or are blind, or have In order for you to go to your dental appointments and for DentaQuest to pay
trouble hearing or understanding, call us if you need extra help. We can for your services, you have to be covered by Medicaid and enrolled in our plan.
tell you if a provider’s office is wheelchair accessible or has devices for This is called having Medicaid eligibility. DCF decides if someone qualifies for
communication. Also, we have services like: Medicaid.

• Telecommunications Relay Service. This helps people who have Sometimes things in your life might change, and these changes can affect
trouble hearing or talking to make phone calls. Call 711 and give them whether or not you can still have Medicaid. It is very important to make sure
our Member Services phone number. It is 888-468-5509, that you have Medicaid before you go to any appointments. Just because you
TTY 800-466-7566. They will connect you to us. have a Plan ID Card does not mean that you still have Medicaid. Do not worry!
If you think your Medicaid has changed or if you have any questions about
• Information and materials in large print, audio (sound); and braille
your Medicaid, call our Member Services Department and we can help you
check on it.
6 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 7
 If you Lose your Medicaid Eligibility Section 8
If you lose your Medicaid and get it back within 180 days, you will be
enrolled back into our plan.
LEAVING OUR PLAN (DISENROLLMENT)
Leaving a plan is called disenrolling. If you want to leave our plan while you
If you have Medicare
are locked-in, you have to call the State’s Enrollment Broker. By law, people
If you have Medicare, continue to use your Medicare ID card when you
cannot leave or change plans while they are locked-in except for very special
need medical services (like going to the doctor or the hospital), but also
reasons. The Enrollment Broker will talk to you about why you want to leave
give the provider your Medicaid Plan ID card too.
the plan. The Enrollment Broker will also let you know if the reason you stated
If you are having a baby allows you to change plan.
If you have a baby, he or she will be covered by us on the date of birth.
Call Member Services to let us know that your baby has arrived and we You can leave our plan at any time for the following reasons (also known as
will help make sure your baby is covered and has Medicaid right away. Good Cause Disenrollment reasons1 :

It is helpful if you let us know that you are pregnant before your baby is born • You are getting care at this time from a provider that is not part of our
to make sure that your baby has Medicaid. Call DCF toll free at 1-866-762-2237 plan but is a part of another health plan.
while you are pregnant. DCF will make sure your baby has Medicaid from the • We do not cover a service for moral or religious reasons.
day he or she is born. They will give you a Medicaid number for your baby. Let
us know the baby’s Medicaid number when you get it. • You are an American Indian or Alaskan Native.
You can also leave our plan for the following reasons, if you have completed
our appeal process2 :
Section 7 • You receive poor quality of care, and the Agency for Health Care
ENROLLMENT IN OUR PLAN Administration agrees with you after they have looked at your medical
records.
When you first join our plan, you have 120 days to try our plan. If you do not
like it for any reason, you can enroll in another dental plan. Once those 120 • You cannot get the services you need through our plan, but you can
days are over, you are enrolled in our plan for the rest of the year. This is called get the services you need through another plan.
being locked-in to a plan. After being in our plan for one year, you can choose • Your services were delayed without a good reason.
to stay with us or select another plan. This happens every year you have If you have any questions about whether you can change plans, call Member
Medicaid and are in the dental program. Services or the State’s Enrollment Broker at 1-877-711-3662
Open Enrollment (TDD 1-866-467-4970).
Open enrollment is a period that starts 60 days before the end of your year in Removal from Our Plan (Involuntary Disenrollment)
our plan. The State’s Enrollment Broker will send you a letter letting you know The Agency for Health Care Administration can remove you from our plan
that you can change plans if you want. This is called your Open Enrollment (and sometimes the SMMC program entirely) for certain reasons. This is called
period. You do not have to change plans. If you leave our plan and enroll in a involuntary disenrollment. These reasons include:
new one, you will start with your new plan at the end of your year in our plan.
Once you are enrolled in the new plan, you will have another 60 days to decide • You lose your Medicaid.
if you want to stay in that plan or change to a new one before you are locked- • You move outside of where we operate, or outside the state of Florida.
in for the year. You can call the Enrollment Broker at 1-877-711-3662
(TDD 1-866-467-4970).
For the full list of Good Cause Disenrollment reasons, please see Florida Administrative Rule 59G-8.600: https://www.
1

flrules.org/gateway/RuleNo.asp?title=MANAGED CARE&ID=59G-8.600
8 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 To learn how to ask for an appeal, please turn to page Section 13, Member Satisfaction, on page 23.
2
9
 • You knowingly use your plan ID card incorrectly or let someone else Before 90 days, your provider must check with us to keep giving your services
use your plan ID card. to you. If your provider is not in our plan, we will help you find a new provider
• You fake or forge prescriptions. that is in our plan, schedule an appointment, and move your health records to
the new provider. If you have questions, call Member Services.
• You or your caregivers behave in a way that makes it hard for us to
provide you with care. Providers in Our Plan
• If the Agency for Health Care Administration removes you from our For the most part, you must use dentists and other dental providers that are in
plan because you broke the law or for your behavior, you cannot come our provider network. Our provider network is the group of dentists and other
back to the SMMC program. dental providers that we work with. You can choose from any provider in our
provider network. This is called your freedom of choice. If you use a dental
provider that is not in our network, you may have to pay for that appointment
or service.
Section 9
MANAGING YOUR CARE You will find a list of providers that are in our network in our provider directory.
If you do not have a provider directory, call 888-468-5509, TTY 800-466-7566
If you have a dental condition that requires extra support and coordination, to get a copy or visit our website at www.DentaQuest.com/Florida.
you may have a case manager with us. If you have a medical condition or
illness that requires extra support and coordination, you may have a case Providers Not in Our Plan
manager with your Medicaid health plan. Whether you have a dental case There are some times when you can get from providers who are not in our
manager or a health plan case manager, your case manager can help you get plan. If you need a service and we cannot find a provider in our plan for
the services you need. Your case manager may work with us to coordinate these services, we will help you find another provider that is not in our plan.
your dental care with your other health care services. If you have a case Remember to check with us first before you use a provider that is not in our
manager assigned by your Medicaid health plan, call Member Services to let provider network. If you have questions, call Member Services.
us know.
When We Pay for Your Services
We will cover most of your dental services, but some services may be covered
by your medical plan. The table below will help you to decide which plan pays
Section 10 for a service.
ACCESSING SERVICES
Before you get a service or go to some dental appointments, we have to make
sure that you need the service and that it is medically right for you. This is
called prior authorization. To do this, we look at your medical history and
information from your dentist, doctor, or other health care providers. Then
we will decide if that service can help you. We use rules from the Agency for
Health Care Administration to make these decisions.

Continuing Your Care

When you first enroll in our plan, you may already be receiving services from
a provider(s). We will make sure you keep getting the care your providers give
you. You can keep getting your care from that provider for up to 90 days.

10 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 11

 Type of Dental Dental Plan Covers Medical Plan Covers: Moral or Religious Objections
Services(s): If we do not cover a service because of a religious or moral reason, we will tell
you that the service is not covered. In these cases, you must call the State’s
Dental Services Covered when you see Covered when you see
Enrollment Broker at 1-877-711-3662 (TDD 1-866-467-4970). The Enrollment
your dentist or dental your doctor or nurse
Broker will help you find a provider for these services.
hygienist
Scheduled dental Covered for dental Covered for doctors,
services in a hospital or services by your dentist nurses, hospitals, and
surgery center surgery centers Section 11
Hospital visit for a Not Covered Covered HELPFUL INFORMATION ABOUT YOUR BENEFITS
dental problem
Choosing a Primary Dental Provider (PDP)
Prescription drugs for a Not Covered Covered One of the first things you will need to do when you enroll in our plan is
dental visit or problem choose a primary dental provider (PDP). This is a general dentist or pediatric
Transportation to Not Covered Covered dentist. You will see your PDP for regular dental visits, or when you have a
your dental service or dental problem. Your PDP will also help you get care from other providers
appointment or specialists. This is called a referral. You can choose your PDP by calling
Member Services.
What Do I Have To Pay For? You can choose a different PDP for each family member or you can choose
You may have to pay for appointments or dental services that are not covered. one PDP for the entire family. If you do not choose a PDP, we will assign a PDP
A covered service is a service that we have to provide in the Medicaid for you and your family.
program. All of the services listed in this handbook are covered services.
Remember, just because a service is covered, does not mean that you will You can change your PDP at any time. To change your PDP, call Member
need it. You may have to pay for services if we did not approve it first. Services.

If you get a bill from a provider, call Member Services. Do not pay the bill until Choosing a PDP for Your Child
you have spoken to us. We will help you. It is important that you select a PDP for your child to make sure they get their
well-child dental screenings each year. These visits are regular check-ups that
Services for Children3 help keep your child’s teeth healthy. These visits can help find problems and
We must provide all medically necessary dental services for our members who keep your child healthy.4
are ages 0 – 20 years old. This is the law. This is true even if we do not cover
a service or the service has a limit. As long as your child’s dental services are You can take your child to a pediatric dentist or dentist.
medically necessary, dental services have:
You do not need a referral for dental services to prevent dental problems and
• No dollar limits; or keep your mouth healthy. Dental services to prevent dental problems and
keep your mouth healthy can be a review of your mouth by a dental provider
• No time limits, like hourly or daily limits
(screenings or exams), teeth cleanings, and thin plastic coatings painted onto
Your dental provider may need to ask us for approval before giving your child the grooves of your back chewing teeth (sealants). These services are free.
the service. Call Member Services if you want to know how to ask for these
services.

Also known as “Early and Periodic Screening, Diagnosis, and Treatment” or “EPSDT” requirements.
3
For more information about the screenings and assessments that are recommended for children, please refer to the
4

“Recommendations for Preventative Pediatric Health Care – Periodicity Schedule” at www.aap.org.

12 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 13

 Specialist Care and Referrals If your condition is severe, call 911 or go to the closest emergency facility
Sometimes, you may need to see a provider other than your PDP for dental right away. You can go to any hospital or emergency facility. If you are not
problems like special conditions, injuries, or illnesses. Talk to your PDP first. sure if it is an emergency, call your PDP. Your PDP will tell you what to do.
Your PDP will refer you to a specialist. A specialist is a provider that focuses
on one type of health service. We pay for emergency services that are provided by a dental provider, even if
they are not part of our plan or in our service area. Medicaid or your Medicaid
If you have a case manager, make sure you tell your case manager about your health plan pays the cost of the hospital or emergency facility and for any
referrals. The case manager will work with the specialist to get you care. care not provided by a dental provider. You also do not need to get approval
ahead of time to get emergency care or for the services that you receive in an
Second Opinions emergency room to treat your condition.
You have the right to get a second opinion about your care. This means
talking to a different provider to see what they have to say about your care. If you have an emergency when you are away from home, get the medical care
The second provider will give you their point of view. This may help you you need. Be sure to call Member Services when you are able and let us know.
decide if certain services or treatments are best for you. There is no cost to
you to get a second opinion. Urgent Care
Urgent Care is not Emergency Care. Urgent Care is needed when you have an
Your PDP, case manager or Member Services can help find a provider to give injury or illness that must be treated within 48 hours. Your health or life are not
you a second opinion. You can pick any of our providers. If you are unable usually in danger, but you cannot wait to see your PDP or it is after your PDP’s
to find a provider with us, we will help you find a provider that is not in our office has closed. Be sure to ask us before you use an Urgent Care center, or
provider network. If you need to see a provider that is not in our provider you may have to pay for those services.
network for the second opinion, we must approve it before you see them.
If you need Urgent Care after office hours and you cannot reach your PDP,
Hospital Care 888-468-5509, TTY 800-466-7566.
If you need to go to the hospital for an appointment, surgery or overnight
stay, your PDP will help to request approval for dental services. We must You may also find the closest Urgent Care center to you by calling
approve a dental provider’s services in the hospital before you go, except 888-468-5509, TTY 800-466-7566.
for emergencies. We will not pay for a dental provider’s services in a hospital There are a few ways to access care after normal business hours, depending
unless we approve them ahead of time or it is an emergency. on you or your child’s needs:
If you have a case manager they will work with you and your dental provider to Providers with extended hours
get services in place for after you leave the hospital.
• Some providers offer evening or weekend office hours.
Emergency Care • Call your PDP or visit their website to find out when they are open.
You have a dental emergency when you need immediate attention to stop
bleeding, relieve severe pain, or save a tooth. Some examples are: Urgent care centers
• Urgent care centers see patients who need immediate, but not
• Abscess emergency attention and their primary dentist is not available.
• Bleeding that will not stop • Some urgent care centers require you to make an appointment, while
• Infection others allow walk-ins. Be sure to call ahead and ask.
Emergency services are what you get when you are very ill or injured. These • Urgent care centers usually focus on medical problems and may not
services try to keep you alive or to keep you from getting worse. They are treat dental problems. Be sure to call ahead and ask.
usually delivered in an emergency room.
14 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 15
 Emergency Room Limitations or Restrictions:
• If your child experiences a life-threatening emergency, call 911 or go to • Eligible enrollees will be eligible for the gift card once per lifetime.
your nearest emergency room. • Member must have one of the following qualifying dental service
within 180 days of enrollment.
Filling Prescriptions
We do not pay for prescription drugs. If your PDP orders a drug for you, we • Eligible members ages 0 – 20 who receive a qualifying dental service.
can help you get that drug through Medicaid or your Medicaid health plan. • Eligible members ages 2 – 3 who have a dental visit.
You can call Member Services if you need help.
• Eligible members ages 19 – 20 who have a dental visit.
Enrollee Reward Programs • Eligible member must opt-in to text messaging program.
We offer dental programs to help keep you healthy and to help you live a
healthier life. We call these healthy behavior programs. You can earn rewards The Healthy Behaviors Incentive Program form is on page 32 of this handbook.
while participating in these programs. Our plan offers the following dental Quality Enhancement Programs
programs: DentaQuest works with Florida Medicaid to offer you oral health services.
Please remember that rewards cannot be transferred. If you leave our plan for DentaQuest may add programs to help improve your oral health. These are
more than 180 days, you may not receive your reward. If you have questions or called quality enhancement (QE) programs. This is how Florida Medicaid
want to join any of these programs, please call us 888-468-5509, explains what a QE program is: “Certain health-related, community-based
TTY 800-466-7566. services to which the Prepaid Dental Health Plan must offer and coordinate
access to its enrollees. Prepaid Dental Health Plans are not reimbursed by the
Agency/Medicaid for these types of services.”
DentaQuest Healthy Behaviors Incentive Program
We care about you. We want you to be healthy. DentaQuest will provide general dental wellness programs for enrollees under
the age of 21. We encourage you and your family to use community oral health
Visiting your primary dentist and having good oral health habits are important. programs. DentaQuest may offer a pilot QE program. A pilot program means
it’s something new. It may only be located in certain areas of the state. A pilot
DENTAQUEST WANTS TO REWARD YOU! QE program could become a statewide program if it works to improve oral
DentaQuest will send you a $20 Walmart gift card if: health. DentaQuest will help you and your family use these programs.
• You get a preventive care visit from your primary dentist. When DentaQuest creates a QE Program, we will:
• And opt-in to the DentaQuest text messaging program. • Explain in writing how the QE program will work;
It’s important to see a dentist to prevent cavities, gum disease and other dental
problems. Dental problems often don’t have symptoms. So you may not even • Explain it in the member handbook or online at www.DentaQuest.com;
know anything is wrong. You’ll have peace of mind if everything is fine, and hope • Offer QE programs in places close to where you and your family live when
it is. But if there are any problems, it’s much easier to take care of them early. possible, and
GET MORE ORAL HEALTH TIPS AT www.DentaQuest.com/Florida. • Work with community agencies and organizations.
• Brush your teeth twice a day.
• Floss at least once a day.
• See the dentist every six months.

16 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 17

 Section 12 Coverage/Limitations
YOUR PLAN BENEFITS: DENTAL SERVICES Children Adults
Service Description (ages 0-20) (ages 21+)
The table below lists the dental services that we cover. Remember, you may
Dental X-rays Internal pictures of All types of dental Only some types
need a referral from your doctor, dentist, or approval from us before you go teeth with different x-rays are covered of dental x-rays are
to an appointment or use a service. Services must be medically necessary in views covered:
• 1 full mouth set of
order for us to pay for them5. You may have a $3.00 copayment per day for a x-rays every 3 years
non-emergency dental visit in a federally qualified health center. • 1 view of the whole
mouth (panoramic)
If there are changes in covered services or other changes that will affect you, x-ray every 3 years
• Other single tooth
we will notify you in writing at least 30 days before the effective date of the x-rays as needed
change. Teeth Cleanings Basic cleanings • Covered 2 times
that may include every year
If you have questions about any of the covered medical services, please call brushing, flossing, • May be done in
Member Services at 888-468-5509, TTY 800-466-7566. scrubbing, and a school or Head
polishing teeth Start program
Fluoride A medicine put on • Fluoride is covered:
Coverage/Limitations teeth to make them • 4 times every
stronger year for children
Children Adults
Service Description (ages 0-20) (ages 21+) that are 0-5 years
old
Dental exams A review of your • Complete exams • Complete exams • 2 times every
tooth, teeth, or are covered 1 time for dentures are year for children
mouth by a dentist every 3 years covered 1 time every that are 6-20
• Check-up exams 3 years years old
are covered 2 times • Emergency exams • May be done in
every year are covered as a school or Head
• Emergency exams medically necessary Start program
are covered as
medically necessary Sealants Thin, plastic • We cover sealants 1
coatings painted into time every 3 years
the grooves of adult for each adult
Dental screenings A review of your • Covered 2 times chewing surface chewing (back)
mouth by a dental every year teeth to help prevent tooth
hygienist cavities • May be done in
• May be done in
a school or Head a school or Head
Start program Start program
Oral Health Education on how • We cover oral health
Instructions to brush, floss, and instructions 2 times
keep your teeth every year
healthy • May be done in
a school or Head
Start program
Space A way to keep space Covered as medically
Maintainers in the mouth when a necessary
tooth is taken out or
missing
Fillings and A dental service to Covered as medically
Crowns fix or repair teeth necessary
SMDPH = Statewide Medicaid Dental Health Plan
You can find the definition for Medical Necessity at http://ahca.myflorida.com/medicaid/review/General/59G_1010_
5

Definitions.pdf
SMDPH = Statewide Medicaid Dental Health Plan
18 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 19
 Coverage/Limitations
Children Adults Your Plan Benefits: Expanded Benefits
Service Description (ages 0-20) (ages 21+) Expanded benefits are extra goods or services we provide to you, free of
Root Canals A dental service to Covered as medically charge. Call Member Services to ask about getting expanded benefits. These
fix the inside part of necessary
a tooth (nerve) extra services are provided to adults that are 21 years or older. For pregnant
Periodontics Deep cleanings that Covered as medically women that are 21 years and older, more services may be available to help
may involve both necessary with a healthy pregnancy.
your teeth and gums
Prosthodontics Dentures or other • 1 upper, 1 lower, or 1 • 1 upper, 1 lower, or 1 Coverage/Limitations
types of objects to set of full dentures set of full dentures Adults Pregnant Adults
replace teeth • 1 upper, 1 lower, • 1 upper, 1 lower, Service Description (ages 21+) (ages 21+)
or 1 set of partial or 1 set of partial
dentures dentures Dental exams A review of your Complete exams are Complete exams are
• 1 flipper to replace • 1 improvement for tooth, teeth, or covered 1 time every covered 1 time every
front teeth denture fit and mouth by a dentist 3 years 3 years
• 1 improvement for comfort (reline) for Check-up exams are Check-up exams are
denture fit and each denture every covered 2 times every covered 2 times every
comfort (reline) for year year year
each denture every Dental screenings A review of your Covered 2 times every Covered 2 times every
year mouth by a dental year year
Prior Authorization: hygienist
Ask us for approval before you go to an Dental X-rays Internal pictures of All types of dental All types of dental
appointment for these services teeth with different x-rays are covered x-rays are covered
views
Orthodontics Braces or other ways Covered as medically
to correct teeth necessary Teeth Cleanings Basic cleanings Covered 2 times every Covered 2 times every
location that may include year year
Prior Authorization: brushing, flossing,
Ask us for approval scrubbing, and
before you go to an polishing teeth
appointment for these
services Fluoride A medicine put on Covered 2 times every Covered 2 times every
teeth to make them year year
Extractions Tooth removal Covered as medically Covered as medically stronger
necessary necessary
Sealants Thin, plastic Covered 1 time every Sealants are not
Sedation A way to provide Covered as medically Covered as medically coatings painted into 3 years for each adult covered
dental services necessary necessary the grooves of adult chewing (back) tooth
where a patient is chewing surface
asleep or partially teeth to help prevent
asleep cavities
Ambulatory Dental services that Covered as medically Covered as medically Oral Health Education on how Covered 2 times every Covered 2 times every
Surgical Center cannot be done in a necessary for any necessary for Instructions to brush, floss, and year year
or Hospital-based dentist office. These dental services needed extractions keep your teeth
Dental Services are services that healthy
need to be provided
with different Prior Authorization: Fillings A dental service to Some fillings services Fillings are not covered
equipment and Ask us for approval before you go to an fix or repair teeth are covered for front
possibly different appointment for these services and back (chewing)
providers teeth as medically
necessary
Periodontics Deep cleanings that Some deep cleaning Some deep cleaning
may involve both services are covered services are covered
your teeth and gums as medically necessary as medically necessary
Extractions Tooth removal Covered as medically Covered as medically
necessary necessary
SMDPH = Statewide Medicaid Dental Health Plan SMDPH = Statewide Medicaid Dental Health Plan
20 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 21
 Coverage/Limitations Make an appointment for a checkup with the dentist today. This is especially
Adults Pregnant Adults
important if you or your child have medical conditions like diabetes or heart
Service Description (ages 21+) (ages 21+) disease that impact your dental health, too.
General Services Dental consultations Covered as medically Covered as medically
to visit a dentist necessary necessary The best part is you can visit the dentist for FREE. As an Florida Medicaid
for an opinion Statewide Plan member, you or your child are eligible for a free dental checkup
and dental pain
treatment every six months. Don’t miss out.
Diabetic Testing Dental office Covered 1 time every Covered 1 time every
diabetes testing year year
Dental Office A visit to the Covered for persons Covered for persons
Visit for Persons dental office to get with intellecutal with intellecutal Section 13
with Disabilities comfortable with
the office and the
disabilities 1 time for
every new dental office
disabilities 1 time for
every new dental office MEMBER SATISFACTION
dentist before dental or dentist or dentist
work is done Complaints, Grievances, and Plan Appeals
We want you to be happy with us and the care you receive from our providers.
Let us know right away if at any time you are not happy with anything about
us or our provider(s). This includes if you do not agree with a decision we have
made.

What you Can Do: What We Will Do:

If you are not happy You can: We will:
with us or our • Call us at any time. • Try to solve your issue
Dental Wellness providers, you can 888-468-5509 within one business
Good oral health care is important for all members of your family. Your teeth file a Complaint TTY 800-466-7566 day.
and smile are the first things that people notice. But, many people think they
don’t need to visit the dentist unless they feel pain in their mouth. If you are not happy You can: We will:
with us or our • Write us or call us at any • Review your
Let us fill you in. A visit to the dentist can keep you or your child from getting providers, you can time. grievance and send
cavities, gum disease and other problems. In fact, most dental diseases are file a Grievance • Call us to ask for more you a letter with our
100 percent preventable with regular care. time to solve your decision within 90
grievance if you think days.
EPSDT (Early Periodic Screening, Diagnosis and Treatment ) is Medicaid’s more time will help. If we need more time
health coverage for children and teens. Blue Cross provides EPSDT services DentaQuest to solve your grievance,
for members under age 21. Examples of some of the dental services are: Attn: Complaints & we will:
Grievances Department • Send you a letter with
• Exam and cleaning every 6 months PO Box 2906 Milwaukee, our reason and tell
WI 53201-2906 you about your rights
• X-rays if you disagree.
Fax: 262-834-3452
• Fluoride treatments and some dental sealants
888-468-5509
• Fillings, extractions and other treatments as medically necessary TTY 800-466-7566

SMDPH = Statewide Medicaid Dental Health Plan

22 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 23
 What you Can Do: What We Will Do: What you Can Do: What We Will Do:
If you do not agree You can: We will: If you do not agree You can: We will:
with a decision we • Write us, or call us and • Send you a letter with our appeal • Write to the Agency • Provide you with
made about your follow up in writing, within 5 business days decision, you can for Health Care transportation to the
services, you can within 60 days of our to tell you we received ask for a Medicaid Administration Office of Medicaid Fair Hearing,
decision about your your appeal. Fair Hearings. if needed.
ask for an Appeal services. Fair Hearing
• Help you complete • Ask us for a copy of your • Restart your services
• Ask for your services to any forms. medical record. if the state agrees
continue within 10 days • Review your appeal • Ask for your services to with you.
of receiving our letter, if and send you a letter continue within 10 days
needed. Some rules may If you continued your
within 60 days to of receiving our letter, if services, we may ask
apply. answer you. needed. Some rules may you to pay for the
DentaQuest - Provider apply. services if the final
Appeals **You must finish the decision is not in your
PO Box 2906 appeal process before you favor.
Milwaukee, WI 53201-2906 can have a Medicaid Fair
Fax: (262) 834-3452 Hearing.
888-468-5509 Fast Plan Appeal
TTY 800-466-7566
If we deny your request for a fast appeal, we will transfer your appeal into the
If you think waiting You can: regular appeal time frame of 30 days. If you disagree with our decision not to
for 30 days will • Write us or call us within give you a fast appeal, you can call us to file a grievance.
put your health in 60 days of our decision
danger, you can ask about your services. Medicaid Fair Hearings (for Medicaid Enrollees)
for an Expedited or DentaQuest – Provider You may ask for a fair hearing at any time up to 120 days after you get a Notice
“Fast” Appeal Appeals of Plan Appeal Resolution by calling or writing to:
PO Box 2906
Milwaukee, WI 53201-2906 Agency for Health Care Administration
Fax: (262) 834-3452 Medicaid Fair Hearing Unit
888-468-5509 P.O. Box 60127
TTY 800-466-7566 Ft. Meyers, FL 33906

1-877-254-1055 (toll-free)
1-239-338-2642 (fax)
[email protected]

If you request a fair hearing in writing, please include the following information:

• Your name
• Your member number
• Your Medicaid ID number
• A phone number where you or your representative can be reached

24 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 25

 You may also include the following information, if you have it: To have your services continue during your appeal or fair hearing, you must
file your appeal and ask to continue services within this timeframe, whichever
• Why you think the decision should be changed is later:
• Any medical information to support the request
• 10 days after you receive a Notice of Adverse Benefits Determination
• Who you would like to help with your fair hearing (NABD), or
After getting your fair hearing request, the Agency for Health Care • On or before the first day that your services will be reduced,
Administration will tell you in writing that they got your fair hearing request. A suspended or terminated
hearing officer who works for the State will review the decision we made.

If you are a Title XXI MediKids enrollee, you are not allowed to have a Medicaid
Fair Hearing. Section 14
Review by the State (for MediKids Enrollees)
YOUR ENROLLEE RIGHTS
When you ask for a review, a hearing officer who works for the state reviews As a recipient of Medicaid and an enrollee in a plan, you also have certain
the decision made during the plan appeal. You may ask for a review by the rights. You have the right to:
state any time up to 30 days after you get the notice. You must finish your
• Be treated with courtesy and respect
appeal process first.
• Have your dignity and privacy respected at all times
You may ask for a review by the state by calling or writing to:
• Receive a quick and useful response to your questions and requests
Agency for Health Care Administration • Know who is providing medical services and who is responsible for
P.O. Box 60127 your care
Ft. Myers, FL 33906
• Know what member services are available, including whether an
(877) 254-1055 (toll-free) interpreter is available if you do not speak English
239-338-2642 (fax) • Know what rules and laws apply to your conduct
[email protected]
• Be given information about your diagnosis, the treatment you need,
After getting your request, the Agency for Health Care Administration will tell choices of treatments, risks, and how these treatments will help you
you in writing that they got your request. • Say no any treatment, except as otherwise provided by law
Continuation of Benefits for Medicaid Enrollees • Be given full information about other ways to help pay for your health
If you are now getting a service that is going to be reduced, suspended or care
terminated, you have the right to keep getting those services until a final • Know if the provider or facility accepts the Medicare assignment rate
decision is made for your Plan appeal or Medicaid fair hearing. If your
services are continued, there will be no change in your services until a final • To be told prior to getting a service how much it may cost you
decision is made. • Get a copy of a bill and have the charges explained to you
If your services are continued and our decision is not in your favor, we may • Get medical treatment or special help for people with disabilities,
ask that you pay for the cost of those services. We will not take away your regardless of race, national origin, religion, handicap, or source of
Medicaid benefits. We cannot ask your family or legal representative to pay for payment
the services. • Receive treatment for any health emergency that will get worse if you
do not get treatment
26 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 27
 • Know if medical treatment is for experimental research and to say yes • Be responsible for your actions if treatment is refused or if you do not
or no to participating in such research follow the health care provider's instructions
• Make a complaint when your rights are not respected • Make sure payment is made for non-covered services you receive
• Ask for another doctor when you do not agree with your doctor • Follow health care facility conduct rules and regulations
(second medical opinion) • Treat health care staff with respect
• Get a copy of your medical record and ask to have information added • Tell us if you have problems with any health care staff
or corrected in your record, if needed
• Use the emergency room only for real emergencies
• Have your medical records kept private and shared only when required
by law or with your approval • Notify your case manager if you have a change in information
(address, phone number, etc.)
• Decide how you want medical decisions made if you can’t make them
yourself (advanced directive) • Have a plan for emergencies and access this plan if necessary for your
safety
• To file a grievance about any matter other than a plan’s decision about
your services. • Report fraud, abuse and overpayment
• To appeal a plan’s decision about your services
• Receive services from a provider that is not part of our plan (out-of- Section 16
network) if we cannot find a provider for you that is part of our plan
OTHER IMPORTANT INFORMATION
• Get care without fear of restraint or seclusion used for bullying,
discipline, convenience, or revenge Emergency Disaster Plan
Disasters can happen at any time. To protect yourself and your family, it is
• Exercise these rights without changing the way DentaQuest or its important to be prepared. There are three steps to preparing for a disaster: 1)
network providers treat you Be informed; 2) Make a Plan and 3) Get a Kit. For help with your emergency
disaster plan, call Member Services or your case manager. The Florida Division
of Emergency Management can also help you with your plan. You can call
Section 15 them at (850) 413-9969 or visit their website at www.floridadisaster.org
YOUR ENROLLEE RESPONSIBILITIES Fraud/Abuse/Overpayment in the Medicaid Program
As a recipient of Medicaid and an enrollee in a dental plan, you also have To report suspected fraud and/or abuse in Florida Medicaid, call the Consumer
certain responsibilities. You have the responsibility to: Complaint Hotline toll-free at 1-888-419-3456 or complete a Medicaid Fraud
and Abuse Complaint Form, which is available online at:
• Give accurate information about your health to your plan and providers
https://apps.ahca.myflorida.com/mpi-complaintform/
• Tell your provider about unexpected changes in your health condition
• Talk to your provider to make sure you understand a course of action You can also report fraud and abuse to us directly by contacting DentaQuest’s
and what is expected of you Member Services at 888-468-5509, TTY 800-466-7566, Monday through
Friday from 8 am to 7 pm to report fraud or abuse.
• Listen to your provider, follow instructions and ask questions
Abuse/Neglect/Exploitation of People
• Keep your appointments or notify your provider if you will not be able
You should never be treated badly. It is never okay for someone to hit you or
to keep an appointment
make you feel afraid. You can talk to your PDP or case manager about your
feelings.
28 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 29
 If you feel that you are being mistreated or neglected, you can call the Abuse To find more information on the Public Health Dental Program, please visit:
Hotline at 1-800-96-ABUSE (1-800-962-2873) or for TTY/TDD at www.flhealth.gov/dental
1-800-955-8771.
To find information on the quality of oral health in your county, please visit:
You can also call the hotline if you know of someone else that is being http://www.flhealthcharts.com/ChartsReports/
mistreated. rdPageaspx?rdReport=ChartsProfiles.OralHealthProfile

Domestic Violence is also abuse. Here are some safety tips: MediKids Information
For information on MediKids coverage please visit: http://ahca.myflorida.com/
• If you are hurt, call your primary care provider medicaid/Policy_and_Quality/Policy/program_policy/FLKidCare/MediKids.shtml
• If you need emergency care, call 911 or go to the nearest hospital. For
more information, see the section called EMERGENCY CARE DentaQuest Texting Program

TEXT SMILE TO
• Have a plan to get to a safe place (a friend’s or relative’s home)
• Pack a small bag, give it to a friend to keep for you

1-850-204-1889
If you have questions or need help, please call the National Domestic Violence
Hotline toll free at 1-800-799-7233 (TTY 1-800-787-3224).

Getting More Information

GET DENTAL
You have a right to ask for information. Call Member Services or talk to your
case manager about what kinds of information you can receive for free. Some
examples are:

HEALTH UPDATES.
• Your enrollee record;
• A description of how we operate;
• Quality performance ratings, including member satisfaction survey
results at www.DentaQuest.com/Florida
DentaQuest will send you texts about your dental
benefits. DentaQuest may also send you oral
Section 17
ADDITIONAL RESOURCES health tips.
Florida Department of Health Information Call 888-468-5509, TTY 800-466-7566 if you
The Public Health Dental Program leads the Department of Health's efforts to
improve and maintain the oral health of all persons in Florida. You can find the have questions about your dental benefits.
following types of information on their website:

• Community Water Fluoridation

• Oral health related sites
• School-based sealant programs

30 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 31

 MEMBER HEALTHY BEHAVIOR INCENTIVE FORM NEW MEMBER SURVEY
To get your $20 Walmart gift card: In order to provide the best care possible, please answer the questions below.
• Return the signed form by mail to DentaQuest. Complete a survey for each Florida State Medicaid Dental Health Program member
in your family. Mail the completed form(s) back to mailing address listed below.
• Receive a qualifying service. Additional new member surveys can be downloaded from www.DentaQuest.com/Florida.
• Opt in to DentaQuest’s text messaging program by providing your
mobile phone number. Your Dental History
Member Name:
Age 0 - 20 years: ( ) I had a dental check up today!
Within 180 days of Medicaid ID Number:
( ) I had a topical fluoride treatment today!
enrollment had one of the
qualifying services. ( ) I got my 2nd molars sealed today! 1. How would you rate your overall oral health?
Ages 2 - 3 years: ( ) I had a dental check up today! Very poor
Ages 19 - 20 years: ( ) I had a dental check up today! Poor
DentaQuest Text Average
( ) I agree to opt-in to the text messaging program!
messaging Program: Good
*Dentist: Please check the service the member received. Very good

Member Information 2. How often do you

a. Brush and floss your teeth?
First Name Last Name Date of Birth b. Have sugary drinks?
c. Do you have City water or Well water?
Mailing Address
3. Do you have dental home and when was your last dental visit?
Yes No
City, State Zip Code Phone
If yes, Month: Year:
Medicaid Member ID Number
4. What did the dentist do at your appointment? Check all
Dentist Information that apply.
(Please sign or stamp to confirm the member above received these services) Check-up (exam and X-rays)
Cleaning
Location Name (please print) Provider Name (please print) Fillings
Tooth ache
Provider Signature Date of Service Root Canal/Crown
Dentures
Other
Provider NPI Number
If you have questions, please call Mail or email the completed form to:
DentaQuest toll free 888-468-5509 DentaQuest, FL Statewide Medicaid Dental Program
TTY 800-466-7566. 8300 NW 53rd Street, Suite 200
Doral, FL 33166
32 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 33
 5. Have you visited the Emergency Department in the last Other Needs
12 months for dental related problems?
9. Do you need help getting the care you need?
Yes No
Yes No
If yes, please explain:

10. If yes, what are the problems that prevent you from getting care? Check all
that apply.
6. Are you currently experiencing any tooth pain or other Transportation
dental issues? Language
Yes No Housing
If yes, can we contact you to assist with scheduling an appointment? Utilities (electricity)
Yes No Food
Other
best number to reach you:

best time/day to reach you: 11. What State Medicaid Managed Care plan are you with?

Other Medical Conditions
We care about our member’s health from head to toe. Chronic medical conditions
12. Who is your Primary Care Provider?
could affect your oral health.

7. Do you have any chronic medical conditions or are
you pregnant?
Mail this form to:
Yes No
DentaQuest
8. If yes, please indicate which chronic condition ATTN: Case Management
Pregnant
8300 NW 53rd Street, Suite 200
Diabetes
Doral, FL 33166
Heart Disease
Kidney Disease
Lung Disease
Cancer
Behavioral Health/Substance Use
Other

34 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 35

 UPDATING YOUR CONTACT INFORMATION Florida Dental Health Program (DHP) Member Contact
Information Form
If your contract information (your name, phone, address or county) has
changed please let us know. You need to let the Florida Department of You need to let DentaQuest and DCF know which Florida State Medicaid
Children and Families (DCF) and DentaQuest know about it. We want to be Dental Health Program member(s) the changes are for.
able to send you information about your Medicaid dental benefits. You may
also contact the Social Security Administration (SSA) to report changes. Member Name:

If you have a change in your contact information, you need to follow these Medicaid ID Number:
steps:
1. Call the Florida DCF at 1-866-762-2237, Florida Relay 711. You can New phone number:
also visit their website at http://www.myflfamilies.com/. Cell Phone Landline

2. Call SSA toll free at 1-800-772-1213 (TTY 1-800-325-0778), Monday New Address
through Friday from 7 a.m. to 7 p.m. You may also contact your local
Social Security office or go online and make changes in your my
Social Security account at https://secure.ssa.gov/RIL/SiView.do.
City State Zip County
3. Fill out this form and mail it to DentaQuest. The address is on the
bottom of the form.
You can also find this form online at www.DentaQuest.com/Florida. Member Name:

Medicaid ID Number:

New phone number:

Cell Phone Landline
New Address

City State Zip County

Mail this form to:

DentaQuest
ATTN: Case Management
8300 NW 53rd Street, Suite 200
Doral, FL 33166

DentaQuest Member Services 888-468-5509, TTY 800-466-7566

36 | www.DentaQuest.com/Florida | Questions? Call Member Services at 888-468-5509, TTY 800-466-7566 37
 11100 W. Liberty Drive
Milwaukee, WI 53224
Inventory number: DQ1276 (9.19) HB/EN