Dental Insurance Frequently Asked Questions

 

Q. What is Voluntary Dental Insurance?

A. An opportunity to help protect and care for your smile – and your family’s – at affordable group rates. You pay plan premiums through convenient payroll deductions.

 

Q. Can I visit any dentist or specialist or only certain ones?

A. With Delta Dental's PPO (Preferred Provider Organization) plan, you and your family members are free to visit any network or non-network dentist or specialist, any time you need care. However, when network dentists are used, you’ll usually spend less out of pocket.

 

Q. Do all my covered family members have to go to the same network or non-network dentists?

A. No. In fact, if they wanted to, every family member could go to a different network or non-network dentist or specialist, every time they need care.

 

Q. What types of dentists are considered specialists and do I need a referral to see one?

A. Specialists include endodontists, periodontists, prosthodontists, and oral and maxillofacial surgeons. No referral is needed in order to see a specialist. If either a network or non-network general practicing dentist suggests you see a specialist, they may recommend one to you – but you are always free to see any specialist you’d like, or choose one from your Delta Dental provider directory.

 

Q. How can I find a network dentist or specialist near me?

A. You may either refer to your Delta Dental provider directory or locate a dentist on the Delta Dental website.

 

Q. What is a plan deductible and/or annual maximum?

A. A deductible is the dollar amount of covered dental expenses you must pay during the year before benefits are paid by Delta Dental. An annual maximum is the maximum amount your dental plan will pay in benefits during the year. Both are generally based on the calendar year. Deductibles and annual maximums apply per covered person.

 

Q. What is co-insurance?

A. For some service categories, you may share in the cost of your dental expenses. This is represented as a percentage of the negotiated fee for covered services. The percentage of co-insurance usually depends on the type of service received (Preventive, Basic, or Major). Network services are typically reimbursed at a higher co-insurance percentage.

 

Q. What is a negotiated fee-for-service?

A. This refers to the set maximum fees for services that have been negotiated with Delta Dental contracted network dentists and specialists. This averages 30% less than the fees they usually charge.

 

Q. If I choose to visit a non-network dentist, will I spend more out-of-pocket?

A. Possibly. That’s because when you or family member sees a non-network dentist, your non-network service charges will be paid for only up to the maximum fee level established with our contracted network dentists. Therefore, any amount above the maximum fee level is your responsibility. You may also have to pay a higher co-insurance level for non-network services.

 

Q. What is pre-treatment review?

A. For all courses of treatment expected to exceed $300, your dentist should submit a report to Delta Dental describing the proposed treatment and itemizing expected charges. Delta Dental will review the report and send the dentist an estimate of benefits that will be paid. This will help ensure that you receive the best and most appropriate treatment necessary. Emergency treatment, oral examinations, cleaning, and x-rays may be performed before the review is prepared.

 

Q. When I visit a dentist, are there any claim forms to fill out?

A. Network dentists have contracted with Delta Dental to submit claim forms and accept benefits directly from Delta Dental. Some non-network dentists may submit claims directly to Delta Dental. More often, however, non-network dentists will require that you pay for services at the time they are rendered. Afterwards, complete a simple claim form and forward it to Delta Dental along with a copy of your payment receipts.