Enrollee Notifications

Language Assistance Programs (LAP)

Language Assistance Program(PDF, 290KB)
LAP Open Enrollment Survey(PDF, 223KB)
In some states, recipients may receive translated copies of selected materials in Spanish or Chinese.

Federal Notices

HIPAA Notices of Privacy Practices (NPP)
HIPAA Notice of Privacy Practices(PDF, 253KB) Other languages: Español中文
Federal regulations require Health Insurance Portability & Accountability Act (HIPAA) covered entities to share information about the entities' Notice of Privacy Practices (NPP) when an individual first becomes an enrollee, or when there are material changes to the notice.
Financial Privacy Notice (Gramm-Leach-Bliley)
GLB Financial Privacy Notice(PDF, 131KB) Other languages: Español中文
Under the Gramm-Leach-Bliley Act (GLB), institutions must notify consumers about the information we collect, why we collect it, what we do with it, and how we protect your privacy. This requirement does not apply to California enrollees. For California enrollees, please refer to the California Financial Privacy Notice.
COBRA Notice
COBRA Notice(PDF, 108KB) Other languages: Español中文
This notice contains important information for COBRA eligible enrollees or current COBRA enrolled members about the right to continue your Dental care coverage
Notice of Non-Discrimination
Notice of Non-Discrimination (PDF, 32KB) Other languages: Español中文
Notice of Non-Discrimination: Delta Dental complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, including sex stereotypes and gender identity. If you believe that Delta Dental has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance electronically online, over the phone with a customer service representative, or by mail. Please visit deltadentalins.com Legal Notices to access Delta Dental’s Notice of Non-Discrimination.

State Notices

California Notices

California Financial Privacy Notice
California Financial Privacy Notice(PDF, 56KB) Other languages: Español中文
Similar to the federal Gramm-Leach-Bliley (GLB) Act, Financial institutions and insurance companies are required to provide notices to their customers about their information-collection and information-sharing practices.
California Timely Access To Care
Timely Access To Care(PDF, 45KB) Other languages: Español中文
California law requires heath plans to provide timely access to care. This law sets limits on how long enrollees have to wait to get appointments and telephone assistance.
Grievance Process
Grievance Process(PDF, 187KB) Other languages: Español中文
California regulations require health plan carriers to inform subscribers and enrollees upon enrollment and annually thereafter of the procedure for processing and resolving grievances. The information shall include the location and telephone number where grievances may be submitted.
Tissue and Organ Donations
Tissue and Organ Donations(PDF, 118KB) Other languages: Español中文
California regulations require every health care service plan to provide, upon enrollment and annually thereafter, a notice regarding organ donation options. This notice informs subscribers of the societal benefits of organ donations and the methods they can use to become organ and/or tissue donors.
Utilization Review and Management
Utilization Review and Management(PDF, 73KB)
California regulations require health plans to provide upon request the criteria or guidelines used for the purposes of utilization review or utilization management functions.

Illinois Notices

Illinois Victims of Violence Notice
Illinois Victims of Violence Notice(PDF, 205KB) Other languages: Español中文
Illinois provides victims of domestic violence the right to keep their health status, location, and provider private. This notice describes how Delta Dental protects domestic violence victims.

Maryland Notices

Maryland Continuity of Care Notice
Maryland Continuity of Care Notice(PDF, 193KB) Other languages: Español中文
New Maryland enrollees transitioning from one carrier to another carrier may have certain rights under Maryland law to continue receiving service preauthorized by the prior carrier.
Maryland Explanation of Coverage (EOC)
Maryland Explanation of Coverage(PDF, 111KB) Other languages: Español中文
Maryland state law requires that each enrollee have electronic access to the Certificate of Coverage (also known as Evidence of Coverage) booklet supplied by Delta Dental. The booklet will be updated and redistributed to you when there are changes to the dental plan.

New York Notices

Domestic Violence
Domestic Violence(PDF, 241KB) Other languages: Español中文
Within New York there are certain protections for victims of domestic violence when an order of protection is provided to the insurer against the policyholder.
FYI: For our New York enrollees
FYI: For our New York enrollees(PDF, 160KB)
Please read this information about Delta Dental of New York’s corporate governance.

Washington Notices

Utilization Management Notice
Utilization Management Notice(PDF, 26KB) Other languages: Español中文
Washington State law requires that enrollees are informed about the Plan’s Utilization Management program. At Delta Dental, we use a process called utilization management to review whether care is medically necessary and appropriate for enrollees.

General Information Notices

2017 Enrollee Notices Flyer
Enrollee Notices(PDF, 38KB) Other languages: Español中文
This flyer outlines the list of legal and privacy notices available to you and gives a brief description about each notice.
Health Education Program
Health Education Program(PDF, 103KB) Other languages: Español中文
The California Department of Managed Health Care require the health plan to provides enrollees with information related to relate to after hours and emergency care services, and eye protection and safety.
Provider Directory Notice
Provider Directory Notice(PDF, 24KB) Other languages: Español中文
This notice informs enrollees of how to access their provider directory.

Contacts

For questions about these notices, please call us at 866-530-9675.

You may also write to us at

Delta Dental of California
P.O. Box 997330
Sacramento, CA 95899-7330