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Contacts

For questions about these notices, please call us at 866-530-9675.

You may also write to us at

Delta Dental of California
P.O. Box 997330
Sacramento, CA 95899-7330

Member notifications

Language Assistance Programs (LAP)

Language Assistance Program   (PDF, 290KB)

LAP Open Enrollment Survey   (PDF, 308KB)

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


Federal notices

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 member, or when there are material changes to the notice.

Financial Privacy Notice (Gramm-Leach-Bliley)

GLB Financial Privacy Notice   (PDF, 131KB) 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 members. For California members, please refer to the California Financial Privacy Notice.

Notice of Non-Discrimination

Notice of Non-Discrimination   (PDF, 32KB) Other languages: Español,  中文

Notice of Non-Discrimination: Delta Dental 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. If you believe that Delta Dental has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance electronically online, over the phone with a customer service representative, or by mail. Please visit deltadentalins.com Legal Notices to access Delta Dental’s Notice of Non-Discrimination.

 

State notices

California notices

Request for Utilization Review and Management Guidelines

Request for Utilization Review and Management Guidelines   (PDF, 27KB)

California regulations require health plans to provide upon request the criteria or guidelines used for the purposes of utilization review or utilization management functions.

California Financial Privacy Notice

California Financial Privacy Notice   (PDF, 56KB) 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.

California Timely Access To Care

Timely Access To Care   (PDF, 45KB) Other languages: Español,  中文

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

Grievance process

Grievance Process   (PDF, 170KB) Other languages: Español,  中文

California regulations require health plan carriers to inform subscribers and members upon enrollment and annually thereafter of the procedure for processing and resolving grievances. The information shall include the location and telephone number where grievances may be submitted.

Tissue and organ donations

Tissue and Organ Donation   (PDF, 118KB) 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.

West Virginia notices

Assignment of Benefits Notice

West Virginia Patient Assignment of Benefits to an Out-Of-Network Provider   (PDF, 49.6KB) Other languages: Español (PDF, 43.1KB)

West Virginia law requires dental plans to honor assignment of benefits, as long as the member is provided with conspicuous notice that the assignment is optional. The attached notice is required to be signed and submitted in order for Delta Dental to honor an assignment request.

Delta Dental of West Virginia ACCESS PLAN   (PDF, 131KB)

Delta Dental Insurance Company ACCESS PLAN Delta Dental PPO DeltaCare USA   (PDF, 133KB)

General information notices

Member notices flyer

Member Notices   (PDF, 37KB) Other languages: Español,  中文

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