Dr. Jmi Asam is an HDS Premier provider accepting new patients. This page is designed to help you understand your Hawaii Dental Service (HDS) coverage for cosmetic dentistry and make informed decisions about your dental care. At Pacific Dental & Implant Solutions (PDIS) in Honolulu, we work closely with HDS to help patients maximize their benefits while providing exceptional dental care.
HDS Dental Coverage Overview
HDS provides varying levels of coverage for cosmetic dental procedures, with benefits typically focused on treatments that improve both function and aesthetics. As an in-network provider with HDS, PDIS can offer you optimal coverage rates and simplified claims processing for your cosmetic dental work.
Plan features typically include:
- Annual maximums ranging from $1,000 to $1,500 depending on your plan
- $50 annual deductible (does not apply to preventive services)
- 12-month waiting periods for major procedures like crowns and bridges
- Coverage up to 50% for major restorative work, subject to plan limitations.
Want help understanding your exact coverage and benefits?
Schedule a free insurance verification with our team, and we’ll break down your specific HDS benefits before you begin treatment.
Network Status
PDIS is an HDS network provider who understands how to maximize your benefits and minimize out-of-pocket costs. This in-network status means:
- Direct claim submission to HDS
- Access to the lowest HDS contracted rates
- Simplified pre-authorization process
- Assistance with benefits verification and claims
Coverage Limits
HDS plans have specific limitations and frequency restrictions for cosmetic procedures:
- Crowns and bridges are covered once every 7 years per tooth
- White crowns and fillings are limited to front teeth and bicuspids
- A 12-month waiting period applies to major restorative work
- Coverage is based on dental necessity and plan guidelines
Waiting Periods
Most cosmetic and major dental procedures require waiting periods before coverage begins:
- Basic services (fillings): 3-month waiting period
- Major services (crowns, bridges): 12-month waiting period
- Root canals and oral surgery: 12-month waiting period
- Gum/bone surgeries: 12-month waiting period
What Cosmetic Dental Procedures Does HDS Cover?
Coverage varies by plan and typically requires procedures to be deemed medically necessary. Here’s a detailed breakdown of common cosmetic procedures and their coverage under HDS plans:
Dental Implants
While not explicitly listed in standard plan coverage, implant components may be partially covered when deemed medically necessary. Your HDS plan may cover the surgical placement under oral surgery benefits and the implant crown restoration under major restorative benefits. Coverage requires pre-authorization and is subject to your plan’s annual maximum and standard waiting periods. Explore HDS dental implant coverage and cost breakdown.
Dental Crowns
HDS covers dental crowns as a major restorative benefit, providing 30-50% coverage depending on your specific plan. A 12-month waiting period applies before coverage begins, and each crown is covered once every 7 years per tooth. Coverage for white crowns is limited to front teeth and bicuspids, and pre-authorization is required before treatment begins. Learn how HDS covers porcelain and metal crowns.
Dental Bridges
Fixed bridges receive similar coverage to crowns under HDS plans, with 30-50% coverage based on your plan type and a 12-month waiting period. Coverage includes both pontics and retainer crowns, with treatment available once every 7 years per tooth. As with all major restorative work, pre-authorization is required to confirm coverage. Review HDS fixed bridge insurance coverage.
All-On-Four
All-on-Four treatment coverage requires strategic planning due to its comprehensive nature. Coverage is typically broken down by components, with implant placement falling under surgical benefits and the prosthesis under major restorative coverage. Pre-authorization is essential, and coordination with medical insurance may be necessary for optimal coverage. See how HDS covers All-on-4 dental implants.
How to Use Your HDS Insurance at PDIS
Using your HDS benefits effectively requires proper planning and documentation. Our team helps guide you through each step:
Verification Process
Before starting treatment, we conduct a comprehensive benefits verification:
- Confirm your plan type and coverage levels
- Check waiting period status
- Verify remaining annual maximum
- Review any plan-specific limitations
- Identify prior treatment history that may affect coverage
Pre-authorization Requirements
Many cosmetic procedures require pre-authorization from HDS:
- Required for all major restorative work
- Includes clinical documentation and x-rays
- Usually takes 2-3 weeks for approval
- Valid for specific time period
- Must be obtained before treatment begins
Coverage Tiers and Network Details
Understanding your plan’s coverage structure helps maximize benefits:
- Preventive services covered at 100%
- Basic services covered at 30-70%
- Major services covered at 30-50%
- Coverage percentages vary by plan
Understanding Your Out-of-Pocket Costs
Deductibles
Your HDS plan includes a standard deductible:
- $50 per person per calendar year
- Does not apply to preventive services
- Must be met before coverage begins
- Applies to basic and major services
Copayments
Your portion of costs depends on service type:
- No copayment for covered preventive care
- 30-70% copayment for basic services
- 50-70% copayment for major services
- Based on HDS’s allowed amounts
Annual Maximums
Plan maximums vary based on your plan type:
- Basic plans: $1,000 per person
- Preferred plans: $1,200 per person
- Deluxe plans: $1,500 per person
- Maximums reset each calendar year
Financing Options
We offer several options to help manage out-of-pocket costs:
- Payment plans
- Healthcare credit cards
- Third-party financing
- Flexible spending account acceptance
Need help financing your dental work?
Next Steps: Schedule Your Consultation
Ready to use your HDS benefits at PDIS? Schedule a consultation below. When you visit, please bring along your HDS insurance card and a valid photo ID. We also recommend preparing a list of your dental concerns and bringing any previous dental records you may have available.
Having these materials ready will help us provide the most comprehensive evaluation of your needs and insurance coverage. We look forward to serving you soon!