Dental rules/benefits



For Members


  • All dental procedures/consultation require prior approval from Nextcare
  • Dental benefit coverage usually has a limit per year, please always check or ask about your dental limits
  • Dental benefits vary according to your insurance coverage plans, please check your poicy details using Nextcare App
  • Always ask about your dental benefits or check using Nextcare App about copayment on dental services before visiting your dentist
  • There is no need to do the dental consultation first then the procedure after few days unless medically required
  • Approval for dental services is usually granted within 20-30 minutes from the time your healthcare provider submits the request to Nextcare
  • Cosmetic dental procedures are usually not covered, please check your policy




For Healthcare Providers


  • All Dental procedures require Pre-Authorization from Nextcare
  • Dental consultation should not be billed when a procedure is performed
  • Each dental procedure performed requires patients signature on the rendered service document on the date of service rendered
  • Specifying the tooth number electronically where applicable
  • Only the initial (diagnostic) x-ray can be billed for treatment. Intra-operative x-rays are considered part of the overall service billing and can not be billed for the patients
  • Inlays/Onlays:
    • Coverage is allowed only when a tooth cannot be restored with a composite filling
    • Onlays are only covered for posterior teeth
  • An x-ray is required for evaluation of the below requests:
    • Crowns
    • Root canal treatment
    • Inlays/Onlays
    • Surgical extractions
    • Impacted teeth extractions
    • Apexification/Apexogenesis
    • Core build up
  • Provisional/temporary crowns are not to be billed separately with routine permanent crowns
  • Core build up:
    • Allowed when there is severe destruction of the tooth structure (more than half the crown is destructed)
    • Cannot be billed with composite filling/inlays/onlays for the same tooth
  • Pulp capping can not be billed when used as liner under a permanent filling
  • Pulpectomy and temporary fillings can be billed separately only in cases of emergency procedure for pain relief
  • Scaling root planning: A periodontal chart with pocket depth or x-ray showing bone loss is required for approval
  • RCT procedure includes pulpectomy and temporary filling