Understanding Your Benefits |
Delta Dental offers plans that provide both choice and affordability.
Under most plans, you can see any dentist and get coverage. But if you see a PPO dentist, you'll pay less for services.
Contact Customer Relations at 1-800-610-0201 for a list of PPO dentists in your area.
Take a moment to find out what plan you're enrolled in. That will help you understand your benefits. To find out if you're in a Delta Dental Premier, PPO, EPO, or Achieve Plan click
on Consumer Toolkit®
or call Customer Relations.
This section highlights the key things you need to know as a member, but is not specific to each group's coverage.
For specific information on your dental coverage, please consult your Benefit Booklet.
For more information, please click on the links below:
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How to Use Your Benefits
You and your family members are covered for dental services when enrolled in one of Delta Dental plans.
Depending on the benefit plan options your employer selected, you may be enrolled in a Delta Dental Premier,
PPO,
EPO,
or Achieve Plan.
With these plan types, you may be responsible for deductibles, coinsurance and copays. Please see your Benefit Booklet for what is covered under your plan.
Or, you may be enrolled in a Patient Direct Discount Plan.
These plans are available for individual purchase or may be offered through your employer group. With these plan types, you receive
significant discounts when using a Patient Direct dentist. There are no claims to file, no annual benefit maximums, no deductibles,
and not waiting periods.
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Eligible Dependents
An employee's spouse and unmarried, dependent children (please see your Benefit Booklet for
details on the dependent age limits) are eligible to be covered under your plan. If you need to add dependents to your
coverage, please see your benefit administrator.
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Visiting the Dentist
With Delta Dental, visiting a dentist is easy. Once you've chosen a dentist, all you need to do is
call to make an appointment. You don't need to inform Delta Dental in advance or ask for a referral to see a specialist.
If you see a participating dentist:
- Your claim will be filed for you.
- You will not have to pay for services upfront.
- You will be responsible for any deductible or coinsurance at the time of service.
If you see a non-participating dentist, you may have to pay for services upfront. You also may need to submit your own claim to Delta Dental
and wait for reimbursement.
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Understanding the Delta Dental Networks
Delta Dental has two dental networks for its commercial insured products - Delta Dental Premier and
Delta Dental PPO. Some dentists participate in one or both networks. The Delta Dental Premier network has more than 2,400
dentists in Colorado, while the PPO network has over 1,000 dentists. Your benefits often are based on the type of dentist you see.
If you're enrolled in an EPO Plan, you must see a PPO dentist to receive benefits.
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Meeting Our Customers' Needs
Delta Dental offers a variety of plan types to meet you and your employer's needs.
Select the plan type that you are enrolled in for more information:
Delta Dental PPO Plan: Offers both choice and care at an affordable price when members
use a PPO dentist.
There are a variety of PPO options - the Maximum Allowable Charge (MAC) and the
Exclusive Panel Option (EPO) plans.
The Delta Dental Premier Plan: a fee-for-service plan with a wide range of
covered services.
Achieve Plan: an innovative new plan designed to maximize the potential for good long-term oral health outcomes.
Delta Dental Patient Direct®: discount plans (not insured products) that offered to employer groups as well as offered for individuals to purchase on their own.
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Pretreatment Estimate
Before beginning treatment that is estimated to cost $400 or more, your dentist may submit your
proposed treatment plan to Delta Dental. Delta Dental will provide an estimate of the benefits payable for the planned
course of treatment. Pre-treatment estimates are not required. They are offered as a service to the member and dentist in
order to allow for appropriate planning. Once the service is completed, the claim should be submitted to Delta Dental for
prompt payment.
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Explanation of Benefits
Delta Dental will notify you in writing of the amount of benefits that are paid on your behalf
and the amount, if any, to pay to your dentist. This is called an Explanation of Benefits. If a service is not covered,
the Explanation of Benefits will tell you the reason. Refer to your Benefit Booklet for detailed information on covered
services, exclusions, and limitations.
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Filing Claims
If you use a Delta Dental participating dentist, your claim will be submitted for you.
If you visit a non-participating dentist, you may need to submit your own claim.
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Common Terms
Click here for a list of commonly used terms.
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