![]() These companies are financially responsible for their own products.ĭelta Dental is a registered mark of Delta Dental Plans Association. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.ĭeltaCare USA plans are underwritten in these states by these entities: CA - Delta Dental of California DC (Policy I-P-DC-dc-20) and FL - Delta Dental Insurance Company MD and TX - Alpha Dental Programs, Inc. For exceptions related to your state and plan, refer to the plan Policy and Benefit Details document.ĭelta Dental PPO plans are underwritten by Delta Dental Insurance Company in AL, DC (Policy IENT-P-CORE-DC-R22), FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California PA, MD – Delta Dental of Pennsylvania NY – Delta Dental of New York, Inc.VSP is a registered trademark, and VSP Individual Vision Plans is a trademark of Vision Service Plan. This webpage links to Delta Dental Plans Association, a national network of 39 independent Delta Dental companies that provide dental insurance.Ask for each plan’s schedule of benefits to compare procedure costs between. Delta Dental Social Impact Report, 2021 For example, Delta Dental charges a 315 copay for molar root canals and more than 700 for a porcelain crown.You may also contact us by calling 80 to request a copy. You may view the DeltaCare USA and Delta Dental PPO Network Access Plan, as required by the Health Benefit Plan Network Access and Adequacy Act, online at.Delta Dental Plans Association Fact Sheet, 2023 and American Dental Association.For example, a plan purchased on July 25 would not be effective until September 1. Plans purchased after the 21st will not be effective until the month after the next.For example, a plan purchased on June 17 would become effective on July 1. Plans purchased by the 21st of the month will become effective on the first date of the following month. Delta Dental PPO Benefits Summary 2022-23 Annual benefit maximums, 1,000 per member, not to exceed a cumulative maximum of 1,000 each benefit year for.For example, a plan purchased on July 15 can be effective August 1, August 15, September 1 or September 15.ĭeltaCare USA plans have a set effective date based on the plan purchase date: Plans purchased on or after the 15th of the month have effective date options of the first of the next month, the 15th of the next month, the first of the month after next or the 15th of the month after next.For example, a plan purchased on July 3 can be effective July 15, August 1, August 15 or September 1. Delta Dental for This Plan that is part of Delta Dental’s Medicare Advantage Premier Network. Plans purchased from the first through the 14th of the month have effective date options of the 15th of the current month, the first of the next month, the 15th of the next month or the first of the month after next.The dates are based on the plan purchase date: Keep copies of the form and documents, and mail the originals to the address at the top of the claim form.Delta Dental PPO plans have flexible enrollment options - you can choose from four effective start dates when you purchase your plan. If any of the information above is missing from the document you receive from your dentist, enter it on the claim form.Ĭomplete, print and sign the form. ![]() Dentist’s Tax Identification Number (TIN).Dentist’s National Provider Identifier (NPI).Description, procedure code and fee for each service performed.Dentist’s name, address and phone number.You can also download the claim form for your plan here:īe sure the dentist signs the form and provides a statement of treatment or a detailed receipt that includes: To do this, log in to your account and select Claims & visits and then "how to file a claim." If you visit a non–Delta Dental dentist and pay upfront, you may need to submit a claim.
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