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Member notifications

Federal notices

HIPAA notice of privacy practices

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

HIPAA notice of privacy practices (NPP)
PDF versions: HIPAA notice of privacy practices (NPP)   (PDF, 69KB), Español中文

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Financial privacy notice (Gramm-Leach-Bliley)

Gramm-Leach-Bliley (GLB)   (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 nondiscrimination

Nondiscrimination disclosure   (PDF, 32KB) Other languages: Español,  中文

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 Legal Notices to access Delta Dental’s notice of nondiscrimination.


Language Assistance Programs (LAP)

Language Assistance Program   (PDF, 290KB)

Language Assistance Program open enrollment survey   (PDF, 308KB)

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


State notices

California notices

CA 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.

CA grievance process

CA 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.

CA timely access to care

CA timely access to care   (PDF, 141KB) 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.

CA tissue and organ donations

CA 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.

CA annual deductible and out-of-pocket maximum accrual

CA annual deductible and out-of-pocket maximum accrual   (PDF, 126KB) 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. Enrollees have the right to request their most up-to-date accrual balance from the health plan at any time.


CA Request Confidential Communications

CA request confidential communications    (PDF, 114KB) Other languages: Español  中文

This notice informs subscribers of methods of contacting the plan when there is a need or desire to provide and alternative address to received protected health information. Users may also choose to use the “Request for Confidential Communication” form when submitting such request.

General information notices

Member notices flyer

Member notices  (PDF, 228KB) 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.


Request for Confidential Communication Form

Request for confidential communication form    (PDF, 123KB) Other languages: Español  中文

Form used to request communication pertaining to protected health information be sent to an alternate location or by alternative method.

Other notices

Assignment of benefits – West Virginia

Patient assignment of benefits to an out-of-network provider   (PDF, 49.6KB) 
Other languages: Español  (PDF, 43.2KB),  

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.

Access to Care - West Virginia

DeltaCare® USA Network Network Access Plan   (PDF, 399KB)
Delta Dental PPO™ Network and Delta Dental Premier® Network Access Plan   (PDF, 409KB)
Delta Dental of West Virginia Network Access Plan   (PDF, 496KB)

Maryland DeltaCare® USA Referral Policy

Maryland DeltaCare® USA Referral Policy   (PDF, 82.5KB) 

Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Document Library - California

Visit the Summary of Dental Benefits and Coverage Disclosure Matrix document library


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