How does my Dental Plan and the Worldwide Dental Emergency Assistance Scheme work?
As a member of a Dental Plan, you will have the peace of mind that your preventive dental care is provided by your dentist in return for convenient monthly payments. The monthly amount that you pay depends on the type of plan. Your Dental Plan Administrator manages and administers your Dental Plan payments using its Direct Debit Originator status. The Dental Plan Administrator also arranges for you to have access to the Scheme which forms an integral part of the Dental Plan and could provide further assistance in the event of Dental Trauma and/or dental emergencies or Oral Cancer. Should you suffer a Dental Trauma, a dental emergency or be diagnosed with Oral Cancer, you may make a request for a payment from the Scheme. The Scheme Manager, at its sole and absolute discretion, may choose to reimburse you either in full or in part for the costs of any necessary treatment. Whatever decision is made, a full explanation will be provided.
What happens in a dental emergency?
At home (within 15 miles of your dental practice): when you are at home you should call your practice to access your dentist’s own emergency arrangements, including the out-of-hours emergency arrangements if appropriate. In the unlikely event that your dentist’s emergency arrangements are not available, and you need to seek treatment elsewhere, you may see a dentist of your choice or we could assist you in finding a dentist. When you are at home, unless the emergency treatment is required as a result of a Dental Trauma, or is outside of normal working hours, you cannot make a request for assistance from the Scheme. Emergency treatment may be covered by your Dental Plan if provided by your dentist or any rota dentist. Your practice will be able to advise you if your Dental Plan includes emergency treatment.
Away from home (more than 15 miles from your dental practice): if you are away from home or overseas you may see any dentist or we could assist you in finding a dentist. The British Consulate, your hotel, holiday representative or hosts may also be able to provide contact details for a dentist in the area. At home or away from home, we can help you find a suitable dentist in the local area and can book you an appointment. Whilst every endeavour will be made to source a dentist and make an appointment, we cannot guarantee that a dentist will be able to see you. At home or away from home, you MUST CONTACT US, IF AT ALL POSSIBLE, TO OBTAIN PRE-AUTHORISATION, BEFORE GOING AHEAD WITH TREATMENT AS YOUR REQUEST FOR ASSISTANCE MAY NOT BE PAID IF IT HAS NOT BEEN PRE-AUTHORISED. If your request for assistance is admitted, we will pay for Emergency Temporary Treatment required at the initial appointment subject to the limits in the Benefits Schedule. You should pay for the treatment, obtain a receipt and submit a Request for Assistance Form.
Why do I need to get my request for assistance pre-authorised?
The Worldwide Dental Emergency Assistance Scheme is a discretionary scheme and therefore the Scheme Manager uses its sole and absolute discretion to decide if the Scheme can make a payment from the Fund to help you. If you have an in-force Dental Plan and your situation meets the guidelines laid down in our Benefit Schedule then in most cases, we are likely to be able to help. Considering each case individually, it is possible that in some cases the Scheme Manager will decide to provide no Benefit. Once we have assessed your situation we can give you a decision on whether we can pre-authorise your request for assistance. If your request for assistance has been pre-authorised you can go ahead and seek treatment which will be paid for by the Scheme subject to the applicable limits as specified in the Benefits Schedule. Once we receive your completed Request for Assistance Form and any associated treatment plan from your dentist, we can arrange for payment of Benefits from the Fund.
What is Emergency Temporary Treatment?
Emergency Temporary Treatment is the initial appointment at any dental practice, or other dental facility for the sole purpose of immediate pain relief and to provide temporary treatment pending subsequent permanent treatment.
Can I request a payment for permanent treatment received during an emergency appointment?
No. Unless the emergency appointment is required as a result of a Dental Trauma, the Scheme provides for Emergency Temporary Treatment. If permanent treatment is received, any payment under the Scheme will be based on the likely cost of Emergency Temporary Treatment had this been delivered in isolation.
I have tripped and damaged a tooth (e.g. in a fall whilst running for a bus). The tooth had already been identified as a tooth requiring treatment; can I make a request for assistance from the Scheme?
If your request for assistance has been pre-authorised you should complete a Request for Assistance Form. The Scheme Manager will investigate both the circumstances surrounding the injury incident and the pre-incident condition of the tooth to determine how much Benefit in the Scheme’s absolute discretion may be paid.
How is the Scheme funded?
Dental Plan Administrators in the Wesleyan Group make payments to the Worldwide Dental Emergency Assistance Scheme, who operate a Fund to be used to help Dental Plan patients if they need assistance. The Fund is managed using actuarial expertise to make sure it has sufficient resources to provide assistance. Payments from the Fund are at the absolute discretion of the Scheme Manager who sets internal guidelines to ensure decisions on what Benefits are paid are consistent and fair and can be met from the Fund’s resources.
How do I obtain pre-authorisation for treatment that is needed as a result of suffering a Dental Trauma or if I need Emergency Temporary Treatment?
During normal working hours (8.00 am to 6.00 pm Monday to Friday). Please call the Assistance Team on 0300 303 5062. Outside of normal working hours (6.00 pm to 8.00 am Monday to Friday, Weekends or Bank Holidays). Please call the Dental Helpline on 0808 169 8118 overseas: (0044) 2891 246005. Whether you are calling the Assistance Team or the Dental Helpline, the dedicated and experienced call handlers will guide you through the process to establish if 1) you need immediate access to a dentist to receive Emergency Temporary Treatment and/or 2) you wish to submit a request for assistance and require pre-authorisation.
Please have to hand the following information:
• Contact details, email and telephone number
• Any medical/dental concerns
• Nature of incident – what, when, how and where.
Where access to an emergency dentist is also required:
• Whether transport is available and distance prepared to travel to a dentist
• Any times unavailable to attend a practice.
Quality Plan Ltd
NDDO, Units 84-85,
Bangor, Co Down
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