- Your benefits may differ from the general information provided here. Review your group contract for specific details regarding coverage under your plan.
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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 enrollees 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; enrollees will have to pay any amount over their plan year maximum.
Delta Dental PPO network — best option for the most enrollee savings.
Delta Dental Premier® network — still contracted, but typically at less savings to the enrollee.
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.
Enrollees 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. Enrollees can simply provide their dentist with their name, date of birth and enrollee ID to verify coverage. They can access ID cards on their mobile device by logging in to Online Services.
No. Enrollees 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.
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, enrollees will receive a plan booklet with defined copayments for covered services. In most states, enrollees must select a primary care dentist in the DeltaCare USA network in order to receive treatment, as in a traditional HMO.
Enrollees must receive care from their selected/assigned primary care dentist within the DeltaCare USA network. (When applicable, Delta Dental will assign one near the enrollee’s home address.)
At the time of service, enrollees pay the dentist only the listed copayment (found in their plan booklet) for covered services.
No. Enrollees can simply provide their assigned dentist with their name, date of birth and enrollee ID to verify coverage, or they can display ID cards from their mobile device by logging in to Online Services.
Enrollees can search for a dentist using the Find a Dentist feature. Enrollees must enter their location and select the DeltaCare USA network from the drop-down menu. For a more targeted search, enrollees can enter the name of a dentist or dental office. Enrollees can read this flyer for more help on finding a network dentist.
To select or change their assigned general dentist, enrollees must register for Online Services. Once registered, they can use the Find a Dentist feature behind login to make dentist selections or updates. Dentist changes made by the 21st of the month will take effect on the first of the following 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.