FAQs


General

What is Choice Builder?
Choice Builder is an ancillary benefits program that offers multiple nationally recognized dental, vision, chiropractic and life carriers - all in one program.


Who is the Group Plan Administrator?
The Group Plan Administrator is an employee of the employer group selected to be the main contact with Choice Builder.


What is a carrier?
A carrier is the participating insurance company providing benefit coverage, e.g. Delta Dental, Ameritas Group, Madison National.


When can carriers and/or benefit plans be changed?
Only during a group's annual renewal period... or if an enrolled employee changes residence to a location where there are no providers under their current benefit plan.


Can each family member select a different benefit plan?
All family members must select the same benefit plan.


What is a benefit plan?
This describes the level of coverage or copayments for office visits and all covered services.


What is renewal?
A company's renewal period (also known as open enrollment) is usually the two months prior to the plan's anniversary date.  All changes made during annual renewal become effective on the anniversary date.


When can dependents obtain coverage?
Eligible dependents may be added only:
  • At the employee's initial enrollment
  • When a new dependent is acquired (within 31 days of birth/adoption/marriage/domestic partner registration)
  • Involuntary loss of other group coverage (within 31 days - proof of loss required)
  • During the annual renewal period


What types of coverage may be offered employees?
An employer may offer employees dental, vision, chiropractic/acupuncture and life.  Some lines of coverage are available based on geographic location.


What benefit plans does Choice Builder offer?
Please click here to see all Choice Builder benefit plans.



What if an employee does not want coverage?
An employee may decline coverage if he/she wishes; however, his/her dependents will not be able to enroll.  In addition, the employee will not be able to enroll with Choice Builder until the employer's next renewal period, unless the employee has a qualifying event (e.g. loss of other group coverage; proof of loss must be provided).


Is there a waiting period before an employee's coverage begins?
The employer must establish a waiting period for new employees.  This waiting period may be 30, 60, 90, 180 or 365 days from the employees' full-time date of hire.  This waiting period must be consistent for all employees since multiple waiting periods are not allowed.  An employer may choose to waive the waiting period for new employees during initial enrollment, but this also must be consistent for all employees.  Newly hired employees added after initial enrollment will be covered under Choice Builder on the 1st day of the month following completion of the waiting period, provided the enrollment form is received no later than 31 days after the eligible effective date.


Does an employee's dependents have to be covered?  If so, does the employer have to pay for them?
Dependents do not have to be covered and there is no participation requirement for dependents.  The employer can, but is not required to pay for the coverage of any dependent but must do so uniformly for all employee dependents. 


How does Choice Builder define an eligible dependent for employers?
Eligible dependents are defined as spouse, registered domestic partner, children born to the employee, stepchildren, adopted children, legal wards, and children of the domestic partner.  Non registered domestic partner coverage is available as an employer option.


When are children no longer considered eligible dependents?
An employee's dependent child is no longer eligible when they cease to be financially dependent on the employee (defined per IRS guidelines), marry, or when he/she exceeds age of eligibility:
  • At the end of the month following their 25th birthday


Will employees be able to keep their current providers?
Yes, if an employee enrolls with a Choice Builder plan that his/her provider is contracted with or if the employee selects a Choice Builder PPO or Indemnity plan.


Is coverage available to employees residing in a different state than the employer's location?
Yes, if the employee selects an indemnity dental plan of a PPO Plan (out of network benefits).  DeltaCare® USA is available in California, Florida, Georgia, and Texas only.


When will an employee receive an I.D. card?
After coverage approval, Choice Builder member I.D. cards are mailed to the employer for distribution to enrolled employees.

Delta Dental sends I.D. cards directly to enrolled employees.
Madison National Life sends I.D. cards directly to enrolled employees.


What is a copayment?
The amount the insured/member must pay for covered services.


Who/What is a Primary Care Dentist?
For members enrolled with Dental HMO benefits, the Primary Care Dentist coordinates all dental needs including basic care, preventative services and referrals to specialists. 





Can employees change their Primary Care Dentist?
Yes, though some restrictions may apply.  Employees should call the Delta Dental Member Services phone number shown on their I.D card.


May an employee visit a specialist without referral from his/her primary care dentist?
Please refer to your Certificate of Coverage for details.


What if a member needs to see a dentist while away from home?
If the member is enrolled in a Dental HMO plan, is away from home and cannot see their Primary Care Dentist, the member will only be covered for emergency treatment.  Members should contact their Primary Care Dentist first to confirm coverage.  If members are unable to get in touch with their Primary Care Dentist, call the Delta Dental Member Services phone number shown on their I.D. card.


What if a member has an emergency dental situation?
In the event of any emergency, members should contact their Primary Care Dentist first (if enrolled in a Dental HMO plan).  Depending on the nature of the emergency, the dentist will either help over the phone, make an appointment for the member as soon as possible, or make a referral for an emergency visit.


What if a member receives a bill?
Although a member should not receive bills for covered dental services provided or approved by the Dental HMO Primary Care Dentist, if a member receives a bill in error, contact the Choice Builder Customer Service Center at (866) 412-9279 for assistance.


What if services are needed before permanent I.D. cards are received?
After coverage approval, member or member's providers may contact the Choice Builder Customer Service Center at (866) 412-9279 for assistance.






Additional Questions?
For additional questions, please call our Customer Service Center at (866) 412-9279 Monday through Friday 8:00 am - 5:00 pm or send an email to us at customerservice@choicebuilder.com.
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