Electronic submission of Dental Care expenses by your dentist will be possible in many situations.
When you enroll into the Plan, you will receive a Certificate of Insurance that has your certificate and group number on it. You and your eligible dependants will use those numbers when claiming benefits at the dentist.
It is important that your dentist has this information. Without it, they will not be able to process an eligible claim electronically.
In most cases, your dental office will file claims electronically. AFBS works with ClaimSecure to provide Members and their covered dependants with pay-direct claims payments for Dental Care coverage. Since these claims are processed through the ClaimSecure network, the dental office requires the information contained on your Certificate of Insurance in your insurance package to process your claim.
If your dental office cannot file claims electronically at the time of service,* you will be able to submit your claims via the ClaimSecure eProfile™ app or on their website.
When submitting a dental claim online, you can either upload a photo (PhotoClaim) or input the relevant information (eClaim).
Electronic submission by your dentist is not possible for all dental claims. For example, dental claims for procedures, including certain x-rays and major restorative work, cannot be submitted electronically. Your dentist will let you know when you need to submit yourself either online using the ClaimSecure eProfile™ app or website or by mail (send the original standard dental claim form completed by your dentist).
Back to topIf your dentist recommends dental work that will cost more than $500 or includes procedures such as crowns, bridgework, veneers, implants, onlays or inlays, you must have your expense pre-determined by AFBS. Your dentist must provide AFBS with specific information, including x-rays, study moulds or casts.
Pre-determination is not required if treatment is the result of an emergency. If the emergency treatment is for a crown or bridge, you must submit x-rays with your claim. Pre-determination is not necessary for a crown if a root canal has been performed on the tooth. The dentist needs to indicate this on the claim form.
Through the pre-determination process, you will have confirmation of the amount eligible for reimbursement through the Plan before treatment starts. Your pre-determination must be submitted by mail to AFBS.
Back to topIf AFBS is the second payor, please include the receipt of claim settlement information, often called an Explanation of Benefits (EOB), from the other insurance company along with copies of the completed standard dental claim form when sending by mail.
Back to topClaims for a previous Benefit Year must be submitted within 90 days of the close of the Benefit Year indicated on your Certificate of Insurance to remain eligible for payment. When coverage is terminated AFBS must receive your claim submissions within 30 days of your coverage termination.
Back to topClaimSecure is a third-party service provider that AFBS works with to provide online claims submission for extended health care, and electronic pay-direct claim settlement for prescription drugs and dental care claims.
AFBS wants to provide your reimbursement to you as quickly as possible and we encourage you to submit your claims online using the ClaimSecure eProfile™ app or their website when possible to speed up this process.
*Electronic submission by your dental office is not possible for all dental claims, including the submission of certain x-rays and major restorative work. You can submit these claims online using the ClaimSecure eProfile™ app or on their website (once it becomes available to you) or by mail. Be sure to include all supporting documentation. Back to top