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Legal and Privacy Notices

Federal notices

Notice of nondiscrimination

 Notice of nondiscrimination (PDF, 64.4 KB) Other languages:  Español,  中文

Dentegra complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, including sex stereotypes and gender identity.

HIPAA notice of privacy practices

 HIPAA notice of privacy practices (PDF, 76.9 KB) Other languages:  Español,  中文

Federal regulations require Health Insurance Portability & Accountability Act (HIPAA) covered entities to share information about the entities' Notice of Privacy Practices (NPP) when an individual first becomes an enrollee, or when there are material changes to the notice.

Financial privacy notice (Gramm-Leach-Bliley)

 Gramm-Leach-Bliley (GLB) (PDF, 29 KB) Other languages:  Español,  中文

Under the Gramm-Leach-Bliley Act (GLB), institutions must notify consumers about the information we collect, why we collect it, what we do with it, and how we protect your privacy. This requirement does not apply to California enrollees. For California enrollees, please refer to the California Financial Privacy Notice.

Language assistance program (LAP)

 Language assistance notice (PDF, 789KB)

In some states, recipients may receive translated copies of selected materials in Spanish or Chinese.

 

State notices

California notices

 CA financial privacy notice (49 KB) Other languages:  Español,  中文

Similar to the federal Gramm-Leach-Bliley (GLB) Act, Financial institutions and insurance companies are required to provide notices to their customers about their information-collection and information-sharing practices

 CA grievance process (PDF, 153 KB) Other languages:  Español,  中文

This notice is to inform subscribers and enrollees of the procedure for processing and resolving grievances. The information shall include the location and telephone number where grievances may be submitted.

 CA timely access to care (PDF, 76.5 KB) Other languages:  Español,  中文

California law requires health plans to provide timely access to care. This law sets limits on how long enrollees have to wait to get appointments and telephone assistance.

 CA tissue and organ donations (PDF, 58 KB) Other languages:  Español,  中文

California regulations require every health care service plan to provide, upon enrollment and annually thereafter, a notice regarding organ donation options. This notice informs subscribers of the societal benefits of organ donations and the methods they can use to become organ and/or tissue donors.

 CA annual deductible and out-of-pocket maximum accrual (PDF, 146 KB) Other languages:  Español,  中文

California law requires health plans to provide enrollees with up-to-date accrual balances towards their annual deductible and out-of-pocket maximum for every month benefits were used until the accrual balances are met.

 

General notices

Enrollee notices

 Enrollee Notices (PDF, 121 KB) Other languages:  Español,  中文

This flyer outlines the list of legal and privacy notices available to you and gives a brief description of each notice.

Other notices

Network development – Connecticut

 Network development (PDF, 35.8 KB) Other languages:  Español,  中文

Dentegra Insurance Company does not tier its network. Dentegra network dentists accept contracting and credentialing requirements set forth by NCQA.

 

Assignment of benefits – West Virginia

 Patient assignment of benefits to an out-of-network provider (PDF, 80 KB) Other languages:  Español, (PDF, 82.4KB)

Dentegra honors assignment of benefits, as required by West Virginia law, as long as we provide conspicuous notice to our enrollees that assigning benefits is optional. Please attach the Assignment of benefits attestation, signed by your Dentegra patient, when submitting claims to Dentegra. Payment for claims processed without the attachment will be made to the Dentegra enrollee.