Member FAQs
You have questions, we've got the answers
Understanding dental insurance
What is the difference between DHMO/EPO and DPPO plans?
Prepaid Dental Plans (DHMO/EPO) have benefits that are ONLY usable at an in-network dental provider. Meanwhile, Dental Preferred Provider Organization (DPPO) plans can be used at any licensed provider – even if they are out of network. To learn more about the differences between Prepaid plans and DPPO plans, read our blog here.
What is the difference between copay and coinsurance?
A copay is the dollar amount you are responsible for paying for the dental service or procedure completed. Coinsurance is percentage based, where Solstice pays a certain percentage for the service, and you pay a certain percentage depending on your plan.
What is out-of-network (OON) and in-network (INN)?
Out-of-Network (OON) refers to providers that are not contracted with Solstice plans. In-Network (INN) refers to providers that are contracted with Solstice plans. Individuals with a prepaid dental plan (DHMO/EPO) can ONLY see In-Network providers while using their benefits.
What is an Explanation of Benefits (EOB)?
An EOB is a statement from your insurance carrier describing what costs your plan covers for services or materials you've received. Solstice will send you EOBs after a provider submits a claim to help make your cost of care is clear.
Enrolling in a plan
How can I enroll with a Solstice plan?
Select “Plans” on the homepage or use our plan selection tool here to enroll in the plan that works for you and your family today!
What plans can I purchase directly with Solstice?
We offer individual plans in the following states: GA, NJ, TN, AZ, OH, IL, FL, and NY. You can purchase a plan online through our Plan Selection Tool or call member services at 877-760-2247. A representative will be available to help you get enrolled today.
Claims & benefits
How do I submit a dental claim?
Most of the time your dental provider will submit your claim to Solstice. However, if you need to send a claim you can mail it to:
Solstice Benefits: PO Box 21157, Eagan, MN 55121.
How long does it take for a claim to be paid?
Dental claims can take up to 30 days to process. If you need to check the status of a claim, login to the MySolstice portal here.
What is the age limit for pediatric dental care?
Children with a Solstice DHMO or EPO specialty plan are covered for dental services at a pediatric dentist up until their 16th birthday.
How can I submit a complaint?
To submit a complaint, you can call member services at 877-760-2247 during the week between 8am and 8pm ET. A representative from the member services team will assist you with all the necessary steps.
Online accounts & ID cards
I cannot make a MySolstice Account – what do I do?
Call member services at 877-760-2247. A representative will be available to help you set up your account.
Will my dependents get their own cards?
No. Solstice generates two ID cards for the policy holder with the policy holder’s information. Dependents can use the policy holder’s card.
Providers
Do I have to be assigned to my dentist?
No. Solstice plans are Open-Access – meaning there are no rosters or dentist assignments to worry about. Just locate a provider and get the dental and vision care you need!
How do I find a dentist?
You can locate a dental or vision provider near you by using our online provider search tool, located here. Alternatively, you can call our member services team at 877-760-2247 weekdays between 8am – 8pm ET. A team member will gladly help you find a provider that works for you and your family.
My plan comes with a prescription discount plan. Where can I find a provider?
Use our Provider Search Feature here. You can also call member services at 877-760-2247 and a representative will help you find the nearest RX provider.
My preferred provider is out-of-network. Can I nominate them to join the network?
Yes. To nominate a provider, call member services at 877-760-2247 and a representative will file the necessary paperwork to help get your provider in-network.