Delta Dental offers a variety of benefit plans, each with different features. While you may have 100% coverage or no copayments for checkups and cleanings, your friend who also has a Delta Dental plan may have different covered benefits. Understanding your plan is the key to unlocking all of the benefits it can offer to you and your family.
Delta Dental offers both group plans and individual plans. Group plans are those typically sponsored by your employer or another organization, while individual plans are purchased by you independently. Delta Dental provides two types of dental plans — fee-for-service and HMO-type plans. Both provide reliable dentist networks and affordable preventive care.
Delta Dental PPO™ is our fee-for-service plan that allows plan members to visit any licensed dentist, anywhere. Covered services are paid based on a percentage, called a coinsurance. For example, if fillings are covered at 80%, you pay the remaining amount. Plans may have an annual maximum and deductible. Plan members get the most plan savings by visiting a PPO dentist.
DeltaCare® USA is our HMO-type plan in which members choose a skilled primary care dentist from the plan network to visit for care. This dentist will coordinate any referrals to a specialist. Covered services provided by the primary care dentist have preset copayments (listed in the plan booklet) and no maximums or deductibles.
The best way to understand how your dental coverage works is to log in to your online account to see your specific coverage details. You can also check your plan booklet or policy to find the specifics of your coverage. No two benefit plans are the same. Most dental plans work within a benefit period, typically one year, that is not necessarily a calendar year (e.g., Nov. 1, 2019 to Oct. 31, 2020).
You can also learn more about how dental benefits work by reviewing some important terms in our insurance terminology glossary.
If you and/or your family members are covered under two different dental plans, you will want to let your dental office know. Depending on your plan's coordination of benefits, Delta Dental will coordinate with your other carrier to share the cost of your treatment. One plan will be considered your primary carrier and pay a larger portion of your benefits, leaving a smaller amount to your secondary carrier. Note that dual coverage doesn’t mean your benefits are doubled — but it can mean added savings on dental costs. Log in to your account for more information on dual coverage.
If you or a family member needs help in a language other than English, Delta Dental can help. Our Language Assistance Program (LAP) is offered free of charge to members and provides customer service phone assistance in more than 170 languages, professional interpretation services to help you communicate with your dentist, written materials in non-English languages and more.
As a Delta Dental member, you have access to discount programs Amplifon or QualSight. Amplifon is a hearing health discount program that partners with a number of leading national brands to provide savings and benefits on hearing aids, batteries, tests and more. QualSight LASIK offers a free exam and savings on LASIK eye surgery. Note that these are not plan benefits.
Go deeper on your specific plan type.
Here's what you need to know about your plan.
When you log in to your online account, you can easily view your claim and visit history by clicking on Claims & visits or Claims. This lets you see the details of the visits you’ve made to the dentist, including what services or procedures you received and what costs were incurred. You can also download claim statements in PDF format for your records.
To find a DeltaCare USA dentist in your area, use our Find a dentist tool. Enter your ZIP code and select DeltaCare USA from the drop-down menu, then search. Want to see different results? Click on Refine search to change the search radius or narrow your results by selecting categories, such as specialty, network and language.
To select or change your primary care dentist…
Make a note of the facility number listed with the office address. Log in to your Delta Dental account and select the Choose provider tab. Check off the radio button next to your name (or the family member’s name you wish to change or add) and then the Add button.
Select Choose provider and input the facility number of the dentist/dental practice of your choice. You can also search by ZIP or have Delta Dental choose a primary care provider for you automatically. Select OK and you’re done.
Changes made by the 21st of the month will take effect on the first day of the following month.
Orthodontic coverage varies depending on your plan, so you will want to log in to your account to review your coverage. Note that you need a referral from your DeltaCare USA primary care dentist to a DeltaCare USA orthodontist to begin treatment. Your orthodontist will submit any paperwork necessary for pre-authorization. In addition to referrals from your primary care dentist, you can call customer service or use the Find a dentist tool to locate a DeltaCare USA network orthodontist near you.
If you began treatment under a different dentist, most DeltaCare USA plans allow you to continue treatment started under a previous dental plan. Work in progress coverage depends on your plan and applies only if you are in active treatment (banding has taken place). See your plan booklet for the full details of your orthodontic coverage.
Here's what you need to know about your plan.
To check your eligibility, log in to your online account and select Benefits overview. This will take you to the Benefits tab, which shows you the eligibility status and history of all members on your plan.
When you log in to your online account, you can easily view your claim and visit history by clicking on Claims & visits or Claims. This lets you see the details of the visits you’ve made to the dentist, including what services or procedures you received and what costs were incurred.
Orthodontic coverage varies depending on your plan, so you will want to log in to your account to review your coverage. You can visit any licensed orthodontist under your plan, but you’ll usually save the most if you choose a Delta Dental orthodontist. Find an in-network dentist by getting a recommendation from your general dentist, calling customer service or using our Find a dentist tool.
If you began treatment under a different dentist, note that work in progress coverage depends on your plan and is typically only available if you are undergoing active orthodontic treatment. See your plan booklet for the full details of your orthodontic coverage.