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Manage Your Small Business Program Dental Plan

Welcome to Delta Dental’s Small Business Program! Below you’ll find information on how to manage your dental plan.

  • This guide can help you manage:

  • Dental plans purchased through Delta Dental’s Small Business Program (SBP).

    If you purchased your plan through a state exchange, you must manage your plan through the exchange. If you purchased through a different program, pool or private exchange, please reference your group welcome materials for plan administration information.

Here’s how to get started on managing your plan:

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Working with a Third Party Administrator (TPA)

The Delta Dental Small Business Program partners with several TPAs to help ensure an exceptional customer experience. Each client is assigned a TPA, who you will contact for inquiries about managing your plan — from enrollment to renewal. This service model can help you focus more on your business, and less on your benefits. View TPA directory.

Your TPA will help you:

  • Manage eligibility and billing

  • Complete (and renew) your group contract

  • Find answers to questions about enrollment, billing and renewal

Your broker will help you:

  • Complete new client documents (like application for coverage)

  • Distribute open enrollment materials and enrollee information about the plan

  • Coordinate with your TPA on any changes to your plan

To better support you and your enrollees, Delta Dental will help you:

  • Understand how to maximize your benefits

  • Answer your enrollees’ benefits and claims questions

  • Share plan information with your enrollees

Understanding benefits basics

As a new client, you’ll receive a welcome kit from your TPA. This typically includes:

  • Your group contract

  • An evidence of coverage (EOC) for your enrollees

  • Instructions on using online services

  • Enrollment forms

  • Instructions to get an ID card

Group contract

Your group contract is your best reference for understanding your plan. Keep it handy as a reference for coverage specifics, limitations and exclusions, and billing and payment details.

When it’s time to renew your plan, your TPA will send you a renewal letter. If you’d like any changes to your plan, your broker will quote any benefit changes, help you fill out a new application and coordinate with your TPA to send you a new contract. You can only make changes to your benefits at renewal.

Eligibility and enrollment

You’ll work with your TPA to compile and manage your eligibility files, so report any changes directly to them. TPAs offer online eligibility management; however, if you prefer to manage your eligibility manually, contact them or your broker for an Enrollment/Change form, which you can email, fax or mail to them directly.

For enrollment changes to be eligible on the first day of the following month, your TPA must receive the changes by the cut-off date below:

Delta Dental PPOSM

DeltaCare® USA

25th day of the month

15th day of the month

Initial enrollment and termination:

  • All eligible employees must enroll within 30 days of becoming eligible or a qualifying event.

  • If you’ve selected dependent coverage, all eligible dependents must also be enrolled at this time. Enrollment for newborn children varies by state; refer to your contract for details.

  • Employee eligibility ends on the last day of the month in which full-time employment ends.

  • Dependent eligibility ends concurrently with the primary enrollee, or when dependent status is lost as indicated in your group contract.

Dental plan billing and payment

TPAs make paying bills simple. Your TPA will either send you monthly statements, or let you view your statements online. Here are a few ways to pay:

  • Pay online through your TPA’s website (if available)

  • Automatic debit from your account

  • Send a check to the address indicated on your invoice

View our TPA directory for contact information.

Late premiums and termination

If your payment is 30 days past due, you’ll receive a past due reminder.

If you receive a termination notice and your plan is terminated due to delinquent premiums, you may reinstate your plan by paying both delinquent and current premiums in full by the date indicated in the termination notice. Note: Your plan’s claims payments may be suspended until your account is current on premiums.

If you choose not to renew your plan, you must send written notification to your TPA prior to the date indicated in your renewal letter. Please refer to your group contract for specific details regarding notification timeframes for contract terminations.

Submitting dental claims

Delta Dental dentists submit claims for your employees who go in network.

However, if an employee chooses to visit a non-participating provider, he or she may need to file a claim.

Online enrollee tools

The easiest way to help your enrollees understand how to use — and make the most of — your group’s dental plan is to suggest that they register for our enrollee Online Services.

Enrollees can view their benefits, print ID cards and find a network dentist1.3 MB.

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