SMILES FOR CHILDREN A Program of the Commonwealth of Virginia DENTAL BENEFITS BOOKLET September 2021 Welcome to the Virginia Smiles For Children Le damos la bienvenida al Programa Dental Dental Program Smiles For Children de Virginia As a member of the Virginia Medicaid, FAMIS or FAMIS Plus programs, it is important Por estar afiliado a los programas FAMIS, FAMIS Plus o Medicaid de Virginia, es for you to read this member handbook about the Smiles For Children program. The importante que lea este manual del afiliado sobre el programa Smiles For Children. information that follows tells you what services are covered by Smiles For Children, La información siguiente trata sobre los servicios cubiertos por Smiles For Children, what the member’s rights and responsibilities are under the program, and how and cuáles son los derechos y responsabilidades del afiliado en el programa, y cómo y where the member may receive additional information. Please take some time to read dónde el afiliado puede recibir información adicional. Dedique algo de tiempo para leer these materials and become familiar with the dental benefits covered under the Smiles estos materiales y familiarizarse con los beneficios dentales que cubre el programa For Children program. Smiles For Children. If you have any questions about Smiles For Children coverage, you can reach Member Si tiene preguntas sobre la cobertura de Smiles For Children, puede comunicarse Services at 1-888-912-3456, Monday through Friday, 8:00 AM - 6:00 PM EST. The TTY/ con el Departamento de servicios para afiliados al teléfono 1-888-912-3456, de lunes a TDD number is 1-800-466-7566. The TTY/TDD line is only for people who have trouble viernes, de 8 a.m. a 6 p.m., EST. El número de la línea TTY/TDD es 1-800-466-7566. La with hearing or speech. Your phone must be equipped to use this line. línea TTY/TDD es únicamente para personas con dificultades auditivas o del habla. Su teléfono debe estar equipado para usar esta línea. Please note you can have a Spanish version of this member handbook sent to you. If you need interpretation/translation services, we can provide a translator for you over Tenga presente que puede solicitar que se le envíe una versión en español de este the phone. Interpretation and translation services are free. For copies of materials in manual del afiliado. Si necesita servicios de interpretación o traducción, le podemos Spanish or for oral interpretations and translation into other languages, please call proporcionar un traductor por teléfono. Los servicios de interpretación y traducción Member Services at 1-888-912-3456. son gratuitos. Si necesita copias de los documentos en español, o interpretación oral y traducción en otros idiomas, comuníquese con el Departamento de servicios para English and Spanish versions of this member handbook are also available on our afiliados al teléfono 1-888-912-3456. websites at www.DentaQuest.com or www.dmas.virginia.gov. Las versiones en inglés y español de este manual del afiliado están disponibles en If it is hard for you to read or understand this guide, please call us at 1-888-912-3456 nuestros sitios web www.DentaQuest.com o www.dmas.virginia.gov. to ask for help. You can ask for this guide in: 1) Larger print Si se le dificulta leer o entender esta guía, comuníquese con nosotros al teléfono 2) An alternative format, such as an audio disk 1-888-912-3456 para solicitar ayuda. Puede solicitar esta guía en: 1. Letra grande To ask questions: 2. Un formato diferente, como un disco de audio. • Call member Services at 1-888-912-3456, Monday through Friday, 8:00 AM - 6:00 PM EST Para hacer preguntas: • The TTY/TDD line is 1-800-466-7566 only for people who have trouble with • Comuníquese con el Departamento de servicios para afiliados al teléfono hearing or speech (your phone must be equipped to use this line). 1-888-912-3456, de lunes a viernes, de 8 a.m. a 6 p.m., EST. • La línea telefónica TTY/TDD es 1-800-466-7566 y es solo para personas con Calls to these numbers are free; we’ll be glad to help you! dificultades auditivas o del habla (su teléfono debe estar equipado para usar esta línea). Las llamadas a estos números son gratuitas. Con gusto le atenderemos. Table of Contents What is Smiles For Children? What is Smiles For Children?..................................................................................................................................................1 Smiles For Children is Virginia’s dental program for Medicaid, FAMIS, or FAMIS Plus. Members enrolled in n, 20 years of age and younger, receive Enrollment....................................................................................................................................................................................................1 Smiles For Childre comprehensive dental benefits. Medically appropriate dental benefits are provided to Services Covered by ..................................................................................................................2 Smiles For Children adult pregnant women enrolled in Medicaid and FAMIS MOMS. Limited dental benefits How to Find A Dentist ......................................................................................................................................................................4 are provided for Medicaid members over age 21. Making Dental Appointments ..................................................................................................................................................5 What to Do in an Emergency ....................................................................................................................................................6 There are no costs for dental care services in the Smiles For Children program. Smiles is a program provided by the Commonwealth of Virginia’s Department of Your Rights and Responsibilities ...........................................................................................................................................6 For Children Medical Assistance Services (DMAS) and is run by DentaQuest. What if I Have Questions ...............................................................................................................................................................8 When and How to File a Complaint or Appeal .........................................................................................................8 Fraud and Abuse ...................................................................................................................................................................................10 Assurance of Non-Discrimination ........................................................................................................................................11 Enrollment Helpful Dental Tips .............................................................................................................................................................................11 Once Medicaid, FAMIS or FAMIS Plus eligibility has been determined enrollment in the program is automatic. You do not need to do anything special to enroll in the program. There is no special Smiles For Children dental card. You may use either the Commonwealth of Virginia plastic ID card or Managed Care Organization (MCO) member ID card (Aetna, Anthem HealthKeepers Plus, Magellan, Optima Family Care, United Healthcare or Virginia Premier Health Plan) for all dental care. You may have additional dental benefits through your MCO. Contact them for more information. Smiles For Children will only pay for dental services while the member is enrolled in Medicaid. REMEMBER, IT IS VERY IMPORTANT to tell your local Department of Social Services right away if you move, change your address or to report any change that affects Medicaid eligibility. If they do not have a correct address then you will not receive up to date information about dental coverage and eligibility will be canceled. If Medicaid, FAMIS or FAMIS Plus enrollment ends, you will receive a letter indicating that your benefits have ended. The program will not pay for any dental services after the end date on the letter. You will have to pay for any services received after the end date on the letter. 1 Services Covered by Smiles For Children Adults (members age 21 and over) who are not currently pregnant Smiles For Children does not pay for dental services for members 21 years of age and Services for Children older except for certain medically necessary oral surgery services when performed There are no costs for your child’s covered dental care services in the Smiles For by a participating dentist. Examples of medically related covered services for adults Children program. include: Smiles For Children members under age 21 are covered for all medically necessary • Oral surgery is covered for non-dental surgical or hospital procedures for birth dental services, as well as orthodontic (braces) procedures provided by a participating defects (like cleft lip and cleft palate), dentist. Dental services include relief of pain and infection, restoration of teeth, and • Removal of cysts and tumors not related to the teeth, maintenance of dental health. An oral screening may be part of a physical exam your • Extraction of teeth for severe abscesses complicating a medical condition or child gets from the doctor, but it does not take the place of the exam by the dentist. contributing to poor general health. Medicaid recommends that your child’s doctor refer your child to