Orthodontic coverage

Preparing for orthodontic treatment? You might be covered for orthodontic services under your Delta Dental plan. To find out, review your Contract, Policy or Evidence of Coverage booklet or check with your benefits administrator.

Your orthodontic coverage and options may vary based on your plan type:

DeltaCare® USA Delta Dental PPOSM and Delta Dental Premier®
Getting startedGetting Started You don’t need a referral to begin orthodontic treatment. However, you will need to visit a DeltaCare USA orthodontist to receive benefits.1 Select any licensed orthodontist under your plan; however, your costs will typically be lower if you choose an in-network orthodontist.
Treatment cost estimatesTreatment cost estimates Costs depend on the services you need. Your orthodontist creates an initial estimate of costs, called a “pre-treatment estimate.” If you agree to proceed, the orthodontist will create a treatment plan with the associated copayments and fees. Costs depend on the services you need, but Delta Dental can help estimate costs before treatment begins. Your dentist can submit a pre-treatment estimate (or you can submit one if you choose a non-Delta Dental orthodontist). We’ll send an overview of the total treatment cost, including how much your plan pays and your share.

Note: A pre-treatment estimate is not a guarantee of Delta Dental’s final payment.

What’s covered?What's covered? Most DeltaCare USA plans1 include:
  • Pre-orthodontic treatment exam
  • Treatment planning session
  • Pre- and post-treatment records (x-rays and study models)
  • Limited, interceptive and comprehensive orthodontic treatment
  • Retention (including retainers)
Coverage varies depending on your plan, but most Delta Dental plans include:
  • Pre-orthodontic treatment visit
  • Exam and start-up records
  • X-rays
  • Orthodontist-recommended tooth extractions
  • Comprehensive orthodontic treatment
  • Retainers (one set typically covered in a lifetime – see below)
  • Post-treatment records
Work in progressWork in progress This coverage depends on your plan and applies only if you are in active treatment (banding has occurred).1 Your orthodontist must complete the Continuous Orthodontic Coverage form. This coverage depends on your plan, and is typically only offered for enrollees undergoing active orthodontic treatment.

Note: Under some plans, you may lose eligibility if coverage has lapsed more than 30 or 60 days.

RetainersRetainers One set of post-treatment retainers is covered. If your benefits cover two-phase orthodontic treatment, retainers are usually covered after each phase. Typically, one set of post-treatment retainers (for orthodontic purposes) is covered in a lifetime. If your benefits cover two-phase orthodontic treatment, retainers are typically covered after each phase.
Invisalign®Invisalign® Invisalign and other specialty appliances are considered optional treatments and will result in additional fees. Some plans may cover alternative appliances like Invisalign. If an appliance is not covered, Delta Dental usually covers some of the orthodontic treatment costs.
ClaimsClaims You do not have to file any claims. Simply pay your copayment for covered services directly to your DeltaCare USA orthodontist. Delta Dental orthodontists will submit claims for you.
PaymentsPayments Orthodontic copayments vary by plan design. Your orthodontist will provide you with payment options (monthly, quarterly, etc.). Orthodontic payment schedules depend on your contract. Your orthodontist will provide you with payment options (monthly, quarterly, etc.).

1Your benefits may differ from the general information provided here. Review your plan booklet for specific details regarding orthodontic coverage under your plan.

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