The initial coverage period is 12 months. Yes, composite fillings are covered for anterior teeth but on posterior teeth the plan will pay the applicable amount it would have paid for an amalgam filling with varying co-pays depending on the plan you choose. Implants are covered at up to 50% with the Enhanced Plan and the Premium Plan. Implants are not a covered benefit un der these plans for individuals 19 years of age and older. For full details, download the plan brochure HERE.ĭownload the brochures below for more information on plan annual maximums. Orthodontia is covered 50% with the Premium Plan. You can access our Medically Necessary Orthodontics Guidelines HERE. You and your dentist will be notified in writing of our decision to approve or deny coverage for the treatment. Your dentist will submit the evaluation rating form, along with other relevant documentation, such as x-rays and photographs of your child’s mouth to Delta Dental - so that we can review the treatment plan. Here’s how it works: your dentist will evaluate your child and complete a form that scores the severity of the condition using a system called the Handicapping Labio-Llingual Deviation (HLD) Index. If you and your dentist do not request authorization for Delta Dental prior to obtaining medically necessary orthodontic services, then no payment will be made after treatment is received. Prior authorization is required before you obtain any treatment. An orthodontic evaluation will help you determine whether your child will qualify for medically necessary orthodontic services. To qualify for medically necessary orthodontic coverage, your child’s condition must be evaluated by a dentist. This unique benefit provides orthodontic services for children with serious orthodontic impairment resulting from congenital abnormalities that affect their daily ability to function, such as speaking or eating. Medically necessary orthodontics is a key element of the Pediatric Dental Essential Health Benefit required under the Affordable Care Act. For individuals under the age of 19, medically necessary orthodontics are covered at 50 percent. To waive waiting periods, please submit a copy of your Certificate of Creditable Coverage verifying your previous dental coverage and a copy of your covered benefits along with your application.ĭownload the brochures below for more information on plan deductibles.įor individuals 19 years of age or older, orthodontic services are not covered under Delta Dental Individual and Family Plan A (Standard and Enhanced), B or C. Waiting periods will be waived if your application is received within 31 days of the termination of your prior carrier you have had at least six months of continuous coverage in basic services and you have had at least 12 months of continuous coverage in major services. We also accept the following credit cards: VISA, American Express, Mastercard and Discover.ĭownload the brochures below for more information on covered services, exclusions and limitations. Members paying annually also have the option to pay with a personal check. If you choose monthly payments, premiums will be automatically withdrawn from the credit card or checking account you enter when you enroll. How do I pay Delta Dental for my dental coverage? View the following videos that give an overview of the coverage with each plan: How can I learn more about your new individual and family plans? We strive to answer every inquiry quickly and accurately. Should you have questions that are not answered here, please contact us. We've assembled a set of frequently asked dental insurance related questions to help you get the answers you need quickly. We know that you have questions when making decisions on dental coverage.
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