Why Choose a Participating
Delta Dentist?
You may choose any licensed dentist. However, it is to your advantage to choose a dentist in the Delta plan. Here’s why:
- Payment will be based on Delta’s maximum plan allowance (MPA) fee. You only have to pay your co-insurance. You are not responsible for charges above the MPA.
- Because Delta reimburses its dentists directly, they agree to charge you no more than your co-insurance and/or deductible. You don’t have to pay the whole bill and wait for reimbursement.
- If a non-participating dentist’s fees exceed the industry average MPA, you must pay the difference plus your co-insurance. You may also have to pay the entire bill in advance.
- Claim forms will be completed and submitted at no charge. Non-participating dentists may require you to complete forms yourself or pay a service charge.
Cleanings
Under both the Premier and Limited PPO plans, you and your dependents are covered for two cleanings and exams, twice in a 12-month period at 100% of Delta Dental’s Maximum Plan Allowance. Cleanings and diagnostic services are a critical part of good dental care. Early detection of decay, gum deterioration, or other problems can be an important factor in saving your teeth and promoting good dental health. Be sure to take advantage of this important benefit.
When Coverage Starts
Your coverage will begin on the effective date of your plan. Benefits are available immediately for any services you receive after the effective date.
If you do not enroll when first eligible, or within 30 days of a life changing event, you must wait until the first annual open enrollment. If you enroll and then drop coverage while still eligible, you must wait until the first annual open enrollment after 12 consecutive months without coverage to re-enroll.
Finding a Participating Dentist
More than 108,000 dentists in the Nation that are located in more than 134,000 dental offices participate in Delta Dental’s Network. To find one near you, visit Delta Dental's website or call Customer Service (see “Health Benefits Contacts” in the front of the Health Benefit section). Or, simply ask your dentist if he/she participates.
The Advantage of Pre-Determination
If you’re thinking about having dental work done that will cost you more than $300, ask your dentist to request a pre-determination before starting treatment. This will let you know approximately how much the work will cost and what your share of the costs will be. Pre-determination does not guarantee benefits.
Optional Services
Optional services are services that cost more than Delta Dental’s normal coverage for that service. When you receive optional service, you are responsible for the extra cost, that is, the amount over the normal Delta Dental benefit.
For example, if your dentist gives you a metal or porcelain inlay when the Delta plan covers amalgam inlays only, Delta will pay the cost of the amalgam only, and you must pay the difference.