Healthy Kids Dental Plan

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IF YOU HAVE A COMPLAINT

CompBenefits is committed to offering outstanding service to its members. To this end, CompBenefits has established a system to respond to complaints related to all aspects of care and services provided by the organization. If you have a concern about your dental care or coverage, the way we manage it, or a decision we have made, we want to know. Our goal is to acknowledge and resolve complaints in a timely manner, in accordance with internal policy and regulatory requirements. We monitor complaints and use this feedback from members to improve our performance.

Definitions

Complaint - a verbal or written expression of dissatisfaction with the plan, regarding any process. A complaint is not a misunderstanding or misinformation that is resolved promptly by supplying the appropriate information or clearing up the misunderstanding to the satisfaction of the member.

Appeal process - the formal process by which the plan offers the subscriber a mechanism to request a secondary review of a complaint resolution.

Complaints

Our Member Services Department is available by phone Monday through Friday, 8:00 AM to 6:00 PM Eastern Standard Time to assist members in addressing any dissatisfaction with their dental plan benefits and/or participating dental office. You can call Member Services at 1-877-531-3026 or submit a complaint in writing. Grievances submitted in writing should be mailed to:

Grievance Department
CompBenefits Corporation
5775 Blue Lagoon Drive
Suite 400
Miami, FL 33126

If you submit a written complaint please include your concern, specific details, dates, and your name and contact information. Should you have any question about submitting a written complaint, call the Member Services Department at 1-877-531-3026. Complaints must be submitted to CompBenefits within one year of the occurrence of events upon which the grievance is based. Your complaint will be acknowledged in writing within five days of receipt. Written complaints will be researched and resolved within 30 days in accordance with the regulatory requirements of the Office of Insurance Regulation. A response and explanation letter with CompBenefits' resolution will be sent to you. The letter will include specific clinical reasons and/or reference to your Handbook and Evidence of Coverage that apply.


 


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