Welcome to Premera’s Dental Eligibility and Benefits Tool.
The dental member information in this tool is very specific to each member’s plan.
Because information can vary across dental classes and within a plan, we recommend you check each member’s eligibility.
To get started, log in to the Premera website using your OneHealthPort user ID and password.
Then select the Eligibility and Benefits link under the tools dashboard.
If you don’t have a OneHealthPort user ID, you can register at onehealthport.com.
In the tool, you can search for a Premera member by member ID or name and date of birth.
Enter the information and click “Search.”
Here you’ll see the member’s specific plan information and eligibility.
Click on “Show full member details” under the ID-suffix to see more member demographic information.
“Show full member details” will give you specific member information.
The eligibility and benefits tool automatically defaults to general medical.
Select “Dental Care” under the Benefit type dropdown box towards the bottom of the page.
Click on “Show more messages” to get detailed contract messaging that applies to the member’s specific plan.
The “Show more messages” section includes things like the missing tooth clause and if the payment is based on the prep or seat date.
You may need to scroll down to see all messages.
Under “Plan details” you’ll see the member’s network and effective date. You can also see if the member has other coverage on file.
If the member has other coverage, click on “Show other coverage details” to see other carrier information and the order of liability or secondary payer.
The tool defaults to the in-network benefits tab.
It shows the deductible type, amount, what’s remaining, maximum allowance, and more.
Here, you’ll also see if the plan is on a calendar year or plan year renewal and the reset date.
Dental services are broken out by classes – preventive, basic, major, other, and not covered.
The classes vary by plan and what benefit they fall into.
This information may vary from member to member in how it’s presented as it’s very specific to the member’s plan.
Here you can see what the member’s limits are and what benefits are available.
For example, let’s look at the benefit for a full mouth panoramic x-ray. If the member has zero visits remaining, you can determine when it’s available again by looking at the “Last date of service”.
If there’s no limit or frequency noted under “Details”, then it’s limited to dental necessity.
You’ll also find specific contract language for a service on the member’s plan, and you can see which services are covered.
Again, this will vary from member to member, because this information is based on their specific plan.
For services like crowns, that may be subject to specific timelines, you can check the member’s tooth history for a list of their claims and services by tooth.
Here you can see the entire treatment history for a specific tooth.
Some services, such as orthodontia, are listed under the “Other services” section.
Orthodontia is usually listed under other services. If it isn’t covered, it will be listed in the “Not covered” section.
Here’s an example of services listed in the “Not covered” section.
Remember that these services will vary based on the member’s plan.
Thanks for your time. We look forward to providing you additional tools and services to make your jobs easier.
In the meantime, here’s more information if you need to register with OneHealthPort or if you have technical issues with the tool.