| Benefits and treatment
Where can I get information about my benefits?
Our web site allows you to view information about coverage for yourself and family members, including maximums and deductibles, benefit levels for standard and orthodontic coverage, and details such as the number of cleanings covered in a year. Log in to the secure system by entering your user name and password in the boxes at the top left of this page. If you don't have a user name or password, click the link to register.
Your Evidence of Coverage (EOC) booklet is also an excellent reference about your dental plan. Offered to every client, this booklet includes information on benefits, contract limitations and exclusions. If you don't already have a copy of your EOC booklet (either a paper copy or on your company's intranet site), please contact your employer.
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Why isn't my eligibility information available on your web site? I have completed my enrollment form.
Online benefits and eligibility information is available after your group's effective date. Please check with your employer for verification.
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How will I get reimbursed?
If you visit a Delta Dental dentist, you do not have to pay the entire bill and wait for reimbursement from us. Delta Dental pays its portion directly to your dentist. We send you a Notice of Payment explaining your portion of the bill. You pay the dentist only that amount. If you visit a non-Delta Dental dentist, you may have to pay the entire bill in advance and wait for reimbursement, so it's to your advantage to select a Delta Dental dentist.
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My dentist says I need three crowns and it sounds like it will be pretty expensive.
Do I need to get preapproval from Delta Dental?
A few Delta Dental plans require preapproval for treatment expected to exceed $200-$300. However, even if your plan does not require it, it is a good idea to know exactly what your share of the cost will be before you receive treatment.
Delta Dental can give you a free estimate, called a "predetermination," based on your records and your dentist's proposed treatment plan. Delta will review your x-rays, diagnosis and coverage, and send a statement back to your dentist detailing what Delta Dental will pay, and what your costs will be.
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Do Delta Dental's plans cover cosmetic dentistry and orthodontics?
These types of procedures are only covered if your employer purchased these benefits in addition to the comprehensive benefits already included in our dental plans. To find out if your benefits include these procedures, check with your benefits administrator or your Evidence of Coverage booklet.
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I am covered by Delta Dental both through my own employer and my spouse's. Does this mean I now get four cleanings a year instead of two?
Having two dental plans (called "dual coverage")does not "double" your coverage. However, it may mean that you will pay lower out-of-pocket costs.
One plan will be considered primary (the one through your work), and the other will be secondary (the one through your spouse's job). If you have children, primary coverage for them is usually determined by the parent whose month and day of birth comes earlier in the year.
Say both you and your spouse's dental plans cover 80 percent for cleanings. Usually, your plan would cover the first 80 percent, and your spouse's plan would cover the remaining 20 percent.
But your spouse's plan may have a non-duplication of benefits rule. This means the second plan would pay only if the first plan paid less than the second would have paid. In this case, the total benefit would be limited to 80 percent. You are responsible for paying the remainder.
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What if I need dental care while I'm out of the country?
You can see any licensed dentist, anywhere in the world for dental services. If you are out of the country and an emergency occurs, seek treatment immediately. ( Delta Dental offers an online international dentist directory to all Delta Dental enrollees.)
Pay the dentist for the services rendered at that time. Be sure to ask for a detailed billing statement that includes: treatment provided, tooth number, date of service and amount of service. If possible, have the billing statement translated into English. This helps us to process your claim in a timely manner. The currency is converted by Delta Dental.
When you return home, forward the statement to Delta Dental, attached to a claim form. You can download and print a claim form here.
What if I am unhappy with the dental care I received?
All Delta Dental dentists are required to meet professionally recognized standards for the quality of their services. If you are unhappy with the care you received from a Delta Dental dentist, Delta Dental can arrange for you to be examined by one of our consulting dentists in your area. If the consultant finds that the work was faulty, Delta Dental will ensure that the original dentist either corrects the work at no additional cost or grants a refund. In that case, you're free to choose another dentist to have the treatment corrected.
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