Yes. Within approximately 7-10 business days from the date of enrollment processed in the Delta Dental eligibility system, you will receive a welcome letter and ID card from Delta Dental welcoming you to the program. You will also receive welcome emails with information on finding a network dentist, establishing yourself as a patient and how to register for an online Member Portal account.
You will receive a welcome letter and ID card at the start of your enrollment. You can print an ID card by logging into the Delta Dental Member Portal after you’ve created your online account. You can also write the alternate ID number that is provided in the Member Portal onto your printed ID card.
The Member Portal allows you to review your dental benefits, print an ID card, review claims history and sign up for electronic Explanation of Benefits (EOBs). You will need to create a username and password to access these online services.
Your alternate ID number is assigned to you by Delta Dental and will be shown on your electronic ID Card when viewed on the Member Portal. The printed ID card mailed to you with the welcome letter will not show your alternate ID number, but you can write it on your printed ID card. Please provide this number or your Social Security number to your dental office for claim submission. For security, it is recommended that you do not write your Social Security number on your ID card.
Two cleanings are covered in a calendar year. Use the online Member Portal to help you track your cleanings to date and when you’re eligible for your next one.
You can choose to visit a dentist who participates in the Delta Dental PPO™ network or Delta Dental Premier® network. A dentist who participates in Delta’s PPO network has agreed to contracted rates for services. By utilizing a PPO provider, you maximize plan benefits and will pay fewer out of pocket costs. The Delta Dental Premier network provides moderate cost savings to you as well. Dentists who participate in the Delta Dental Premier network typically have higher fees than PPO providers, but Premier dentists have agreed to maximum charges for services. PPO and Premier dentists will not “balance bill” you for services.
No. If you choose to receive services from a dentist who is not a Delta Dental participating provider, your benefits will be paid in accordance to the plan’s out-of-network schedule of benefits. You will receive the most savings when you receive services from a dentist who participates in the Delta Dental PPO network and moderate savings when you utilize a dentist who participates in the Delta Dental Premier network. If you choose to receive services from a dentist who does not participate in either the Delta Dental PPO or Delta Dental Premier networks, you will be responsible for the difference in the plan’s out-of-network allowed amount and the dentist’s submitted charges.
The following table shows an example of savings you may expect when visiting a Delta Dental PPO network dentist or a Delta Dental Premier dentist as compared to the cost of treatment from a non-Delta Dental, non-contracted dentist. These are hypothetical numbers for illustrative purposes only and assume that no maximums or deductibles apply.
|Dentist's charge for a crown|
|Delta Dental PPO™||$1,000|
|Delta Dental Premier® Dentist||$1,000|
|Non-Delta Dental Dentist*||$1,000|
|Contract allowance (amount on which Delta Dental bases its payment)|
|Delta Dental PPO™||$640|
|Delta Dental Premier® Dentist||$800|
|Non-Delta Dental Dentist*||$900|
|Coinsurance (% of contract allowance Delta Dental will pay)|
|Delta Dental PPO™||90%|
|Delta Dental Premier® Dentist||90%|
|Non-Delta Dental Dentist*||60%|
|Delta Dental's share|
|Delta Dental PPO™||$576|
|Delta Dental Premier® Dentist||$720|
|Non-Delta Dental Dentist*||$540|
|Delta Dental PPO™||$64|
|Delta Dental Premier® Dentist||$80|
|Non-Delta Dental Dentist*||$360|
|Balance billing (any amount over the contract allowance that member is paying)|
|Delta Dental PPO™||$0|
|Delta Dental Premier® Dentist||$0|
|Non-Delta Dental Dentist*||$0|
Delta Dental PPO™
Delta Dental Premier® Dentist
Non-Delta Dental Dentist*
|Dentist's charge for a crown||$1,000||$1,000||$1,000|
(amount on which Delta Dental bases its payment)
(% of contract allowance Delta Dental will pay)
|Delta Dental's share||$576||$720||$540|
(any amount over the contract allowance that member is paying)
If you choose to seek treatment from a non-network dentist, you will experience more out-of-pocket costs because you will be responsible for paying the difference between the plan’s allowed amount and the dentist’s submitted charges. Generally, you are required to pay your dentist in full and submit claims for reimbursement to Delta Dental. Delta Dental will send the reimbursement payment directly to you unless you sign the “Assignment of Benefits” section of the claim form, which authorizes Delta Dental to send the reimbursement payment directly to your dentist. Before signing that section, you must first confirm whether your dentist will accept the assignment of benefits.
When the member has either a FEHB plan or coverage under one of the FEDVIP plans that has any dental coverage, it will always be the primary carrier. The member’s FHFA dental coverage should be submitted by the member’s dentist after one or both FEHB or FEDVIP coverage(s) has been billed and payment processed to include payments made.
Delta Dental will process orthodontic claims for those who have treatment in progress. First, you will need to inform your dentist of the change in insurance companies. Then in January, you should ask your orthodontist to submit the original orthodontia claim to Delta Dental with the total number of treatment months listed and the initial banding date. Payments will be prorated based on the number of months of treatment remaining.
Since treatment has not started yet, you must request that your dentist submit another predetermination of benefits to Delta Dental for services that will be provided in 2023.