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The information below applies to our standard processing policies and contract coverage, and is to be used only as a guide. Your group contract serves as the controlling document of your plan.
PPO stands for Preferred Provider Organization. This means Delta Dental network providers accept a contracted fee as payment in full for covered services (the contracted fee is usually lower than the provider’s normal fee.) While members will usually save the most with a Delta Dental PPO network dentist, they are free to visit any licensed dentist.
Patients pay a percentage of the contracted fee — called coinsurance — and the plan pays the rest. The percentage varies with each category of service (diagnostic and preventive, basic, major, etc.). If applicable, a plan deductible must be satisfied for certain covered services before we begin paying benefits; members will have to pay any amount over their plan year maximum.
Delta Dental PPO network — best option for the most member savings.
Delta Dental Premier® network — still contracted, but typically at less savings to the member.
Network dentists have agreed to charge Delta Dental patients contracted fees for covered services. Dentists cannot balance bill patients for charges in excess of what is outlined in the patient’s Explanation of Benefits (EOB) and Network dentists must submit claims to Delta Dental on behalf of their patients. Members covered under a Delta Dental PPO Plan will typically have the lowest out-of-pocket costs when visiting a Delta Dental PPO dentist.
Members pay their coinsurance directly to the dentist at the time of treatment. They will not have to file a claim form if they use a Delta Dental dentist.
No. Members can simply provide their dentist with their name, date of birth and member ID to verify coverage. They can access ID cards on their mobile device by logging in to Online Services.
No. Members can visit any licensed dentist that they choose, without pre-authorization or referral. However submitting a pre-authorization is recommended when costly treatment is being performed to assure all services are covered benefits under the plan.
Delta Dental offers two virtual dentistry options for members.
Toothpic is a photo-based platform that lets members get an in-depth diagnostic report from a Delta Dental dentist within 24 hours of submitting photos of their mouth, teeth and gums.
Delta Dental – Virtual Consult: This video-based tool lets members schedule video consultation appointments with Delta Dental dentists. It’s perfect for members with more serious concerns, including those who may need a prescription for pain or infection management.
The information below applies to our standard processing policies and contract coverage and is to be used only as a guide. Your group contract serves as the controlling document of your plan.
DeltaCare USA is a closed network product¹ that features set copayments, no annual deductibles and no maximums for covered benefits. Upon enrollment, members will receive a plan booklet with defined copayments for covered services. In most states, members must select a primary care dentist in the DeltaCare USA network in order to receive treatment, as in a traditional HMO.
Members must receive care from their selected/assigned primary care dentist within the DeltaCare USA network. (When applicable, Delta Dental will assign one near the member’s home address.)
At the time of service, members pay the dentist only the listed copayment (found in their plan booklet) for covered services.
No. Members can simply provide their assigned dentist with their name, date of birth and member ID to verify coverage, or they can display ID cards from their mobile device by logging in to Online Services.
Members can search for a dentist using the Find a Dentist feature. Members must enter their location and select the DeltaCare USA network from the drop-down menu. For a more targeted search, members can enter the name of a dentist or dental office. Members can read this flyer for more help on finding a network dentist.
To select or change their assigned general dentist, members must register for Online Services. Once registered, they can use the Find a Dentist feature behind login to make dentist selections or updates. Changes requested between the first and 15th of the month are effective immediately. Changes received on or after the 16th of the month will be effective on the first of the next month.
Yes, with a referral from the child’s assigned general dentist. However, benefits provided by a pediatric dentist are generally limited to children through age seven following an attempt by the assigned primary dentist to treat the child. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis.
Delta Dental PPO™ is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California; PA, MD – Delta Dental of Pennsylvania; NY – Delta Dental of New York, Inc.; DE – Delta Dental of Delaware, Inc.; WV – Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.
DeltaCare USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MA, ME, MI, MN, NC, ND, NE, NH, OK, OR, RI, SC, SD, VT, WA, WI, WY — Dentegra Insurance Company; AK, CT, DC, DE, FL, GA, KS, LA, MS, MT, TN, WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NM — Alpha Dental of New Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania; VA – Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products.