Delta Dental Insurance VADIP frequently asked questions

Please complete the HIPAA Authorization form. 

The services covered by VADIP can be found on the Enrollee Support page in the plan benefits booklets in the Resources section.

Yes, Delta Dental offers high-quality dental coverage for your family members not enrolled in VADIP or not eligible for CHAMPVA. One family member must be over the age of 18 to enroll. We make it easy to find the right dental plan. If you live in AL, CA, DE, FL, GA, LA, MD, MS, MT, NV, NY, PA, TX, UT, WV or DC, call 888-216-8330 to learn more, get a quote or begin enrollment. Visit our Get a Quote page for complete information on where Delta Dental offers coverage. Please note, any separate dental insurance purchased through Delta Dental is not affiliated with VADIP or endorsed by the VA.

Within the lock in period of 12 months you may move up, but not down. For example, you can move from Enhanced to Comprehensive, Comprehensive to Prime or Enhanced to Prime but you may NOT move from Prime to Comprehensive, Comprehensive to Enhanced or Prime to Enhanced.

If you choose to move up from Enhanced or Comprehensive, the lock in period (12 months) starts over again and any money used from the maximum in your first plan would follow. For example, if you use $100 while in the Enhanced plan and then within the lock in period you decide to move up to the Comprehensive plan, the $100 you used while in the Enhanced plan would now come out of the maximum for the Comprehensive plan.

Delta Dental is committed to making sure you have all the information you need to make the right decision for you and your family. If you’d like to know more about Delta Dental’s Veterans Affairs Dental Insurance Program call us at 855-370-3303. Customer service representatives are available Monday through Friday, 8:00 a.m. to 8:00 p.m., Eastern Time.

You might think an EOB is a medical bill, but it actually gives you details regarding how your dental claim was processed. The EOB will also tell you what portion of a claim was paid to your dentist and what portion of the payment, if any, you are responsible for.

Sign into the Member Portal.

Once you turn off your paper Explanation of Benefits (EOB) statements, you will receive email alerts to notify you when a dental claim is processed. You can view and print your Dental Explanation of Benefits (EOB) Statements from Member Portal.

Your Dental Explanation of Benefits (EOB) statement history will remain online for a minimum of two years plus the current year.

As long as you are enrolled in VA healthcare, you are eligible for the VADIP plan offered by Delta Dental—regardless of your service rating. You can compare the benefits available under the Enhanced, Comprehensive and Prime plans to find out which of Delta Dental’s VADIP plans is right for you. Delta Dental has succeeded in streamlining its service and administrative costs to be able to offer these plans to Veterans at a very affordable rate and also provides access to a broad network of dentists to help keep enrollees’ out-of-pocket expenses as low as possible.

Yes, dentures are included as covered benefits under our VADIP Comprehensive Plan.

Beginning 1/1/2023 the waiting period for major restorative dental services will reduce from 12 months to 9 months.

The VA Dental Insurance Program (VADIP) offers Veterans who are enrolled in the VA health care system and eligible beneficiaries of the Civilian Health and Medical Program of the VA (CHAMPVA) the opportunity to purchase dental insurance.

Yes, there is a monthly premium cost based on the plan you choose and where you live (ZIP code) to enroll in the VADIP program. Monthly premiums are paid with a credit card or through Electronic Funds Transfer (EFT). Premiums can be found by checking the Rate Calculator.

Yes, each new subscriber must fulfill an initial 12-month enrollment period. After the initial 12-month period, you can continue on a month-to-month basis as long as you remain eligible and pay your monthly premium.

Participation in VADIP will not affect Veterans' eligibility for VA dental services and treatment.

Delta Dental of California is a specific company within The Delta Dental Plans Association that provides dental coverage to more than 75 million people in the U.S. It is Delta Dental of California that underwrites the Veterans Affairs Dental Insurance Program.

With VADIP, you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist, plus referrals are not necessary for specialty care. But, when you visit an in-network dentist, you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower.

The time it takes to process a claim depends on the type of service performed. Most claims flow through our system quickly and efficiently, with 99% being processed within 10 business days. If additional information is needed for a claim, it may take longer.

Dentist Directory for a list of network dentists in your area. Just enter your ZIP code and the distance you are willing to travel, and you’ll be connected with a list of VADIP network dentists that meet your search criteria. With network dentists in more than 240,000 locations nationwide, it’s more than likely that we’ve got your area covered!

If you move, it is very important that you contact Delta Dental right away so that we can update your records. Having accurate name, address and other contact information such as your phone number and email address on file for our VADIP enrollees will help avoid claims processing delays and misdirected claim payments as well as ensure that your account is credited with the correct premium payment amount each month as changing your address may affect your payment amount. Updating your address through the VA Healthcare System does not automatically update the address information we have on file. You can easily update your contact information using the online Customer Service Inquiry Form. 

For a list of all VA facilities and the services they offer, please visit VA’s website.

I understand the 12-month lock-in period once you enroll. However, are there any circumstances that would allow me to disenroll within those first 12 months:

1. During the 30-day grace period following your coverage effective date, provided you have not already used any of the benefits.
2. If you relocate outside of the area covered by the VADIP program and are no longer able to use the benefits.
3. If you have a serious medical condition that precludes you from using the benefits provided under the program, or if continuing to be enrolled in VADIP would cause a serious financial hardship.

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.

The best way to take full advantage of your dental coverage is to understand its features. Our best advice is to read your benefits information before you go to your dentist.

• Most insurance companies offer a variety of benefit plans with different features. You may have co-workers or friends who also have dental insurance, but their coverage may differ from yours.
• You have the freedom to choose any licensed dentist. If your dentist participates in the network, he or she will submit your claim. If your dentist does not participate, you may be responsible for paying your dentist in full and submitting your claim to Delta Dental or another insurance carrier.
• If you are entitled to benefits from more than one group dental plan, the amounts paid by the combined plans will not exceed 100 percent of your dental expenses. Benefits for dependents vary from plan to plan. Pay particular attention to special clauses and to language about dependents.
• Dental benefits are calculated within a calendar year. Check your benefits information so that you know when you might be approaching your deductible payments or plan maximums.

What are “maximums”?

Most dental plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period. The patient is personally responsible for paying costs above the annual maximum.

What are “deductibles”?

Our three plans have specific dollar deductibles. It works like your car insurance. You personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Your plan information will describe how your deductible works.

What is “coinsurance?”

Many insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. What you pay is called the coinsurance, and it is part of your out-of-pocket cost. It is paid even after a deductible is reached.

What are “reimbursement levels”?

Delta Dental’s Veterans Affairs Dental Insurance Program offers three classes of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.

Here is the way the three levels typically work:

• Class A procedures are diagnostic and preventive and typically are covered at the highest percentage. This gives patients a financial incentive to seek early or preventive care, because such care can prevent more extensive dental disease or even dental disease itself.
• Class B includes basic procedures – such as fillings, extractions and periodontal treatment – that are sometimes reimbursed at a slightly lower percentage.
• Class C is for major services and is usually reimbursed at a lower percentage. There is a 12-month waiting period under the Comprehensive and Prime plans.
  
  

What are “negotiated fees”?

A negotiated fee refers to the amount participating providers agree to accept as payment in full for covered services. It is usually lower than their normal charge. When you use an in-network dentist, you are responsible only for the difference between your plan’s benefits payment amount and the negotiated fee for the services rendered.

Can I estimate my dental costs for treatment?

If your dental care will be extensive, you may ask your dentist to complete and submit a request for a cost estimate, sometimes called a pre-treatment estimate. This will allow you to know in advance what procedures are covered, the amount the benefit plan will pay toward treatment and your financial responsibility. A pre-treatment estimate is not a guarantee of payment. When the services are complete and a claim is received for payment, Delta Dental will calculate payment based on your current eligibility, amount remaining in your annual maximum and any deductible requirements.

What are “Limitations and Exclusions”?

International participants are able to register and access the Member Portal. With access to the Member Portal, users can print an enrollment card, check the status of a dental claim, and review any claims processed to date.

Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.

Allowances for some procedures covered under your benefits may be subject to limitation or denial based upon clinical criteria applied by Delta Dental’s licensed dentist consultant staff. We maintain written guidelines for the use of clinical criteria in making benefit determinations. You may obtain a copy of such guidelines for:

• Basic benefits
• Crowns, inlays, onlays and cast restoration benefits
• Prosthodontic benefits

Simply send us a request in writing for the specific benefit category or dental procedure range.

The materials provided to you are guidelines used to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

The first option, EFT, is the transfer of funds between bank accounts by electronic means rather than by a more conventional paper-based manual method such as writing a check. Electronic funds transfer is a fast, easy and convenient way to pay your monthly premiums directly from your bank account.

A recurring charge to your credit card is also an allowable method of paying your monthly premiums. With either EFT or a recurring charge to your credit card, your premium payments will always reach Delta Dental quickly and on time, and you’ll never risk a possible lapse in coverage because you forgot to pay your monthly premium.

Your EFT or recurring credit card charge will be set up with your bank within five days after Delta Dental has received your application. The transfer of funds by EFT will take place on the sixth of every month or the following business day if the sixth is a non-business day (i.e., Saturday or Sunday) or holiday.

If Delta Dental is unable to receive funds from the electronic transfer, your EFT or RCC will be cancelled immediately. You will receive written notification that your “payment method on file was rejected.” If you do not re-establish an EFT or RCC payment of your monthly premiums, your coverage may be terminated.

You can securely update or change your existing payment method online by logging onto the Member Portal. 

To change or update a credit card/debit card, please make sure to include the correct name on the card, the card number, security code and the expiration date of the card that you wish to use for your recurring credit card (RCC) payments.  Please note that we accept Visa, Mastercard and Discovery only. 

To change or update your Electronic Funds Transfer (EFT) information, please be sure to provide the correct ABA/Routing Number and the account number of the bank”.

No. Depending on your financial institution’s normal business practices, the electronic transfer of funds takes place on the sixth of every month or the following business day if the sixth is a non-business day as noted above. Your credit card will be charged for your premium payment on the sixth of every month or the following business day if the sixth is a non-business day.

No. With EFT, the bank will never transfer more than your current monthly premium from your account.

Yes, Delta Dental will use your current payment method on file to collect any past due amount. We will only collect up to but not more than 2-months of your current monthly premium at a time. Therefore if your past due balance is more than the 1-month of your monthly premium on file, we may pull the additional amount due over several months. You will receive notification advising of any past-due premium amount that will include options for paying the past-due amount separately from your EFT withdrawals or RCC on file in order to bring your account to a current status.

Yes. Your EFT or RCC charge will stop once your enrollment is terminated. If the termination of your enrollment is effective on the first of the following month, a withdrawal of funds or a charge to your credit card for your current month’s premium payment will still occur unless you previously requested that Delta Dental stop your EFT or RCC charges immediately. (Note: You will be required to make an alternative payment arrangement at the time you make this request.)

You can securely update or change your existing payment method online by logging onto the Member Portal. 

To change or update a credit card/debit card, please make sure to include the correct name on the card, the card number, security code and the expiration date of the card that you wish to use for your recurring credit card (RCC) payments.  Please note that we accept Visa, Mastercard and Discovery only. 

To change or update your Electronic Funds Transfer (EFT) information, please be sure to provide the correct ABA/Routing Number and the account number of the bank”.