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FAQ:
Benefits and treatment
Find answers to
the questions below.
Where
can I get information about my benefits?
Our web site allows you to view
information about coverage for yourself and
family members, including maximums and deductibles,
benefit levels for standard and orthodontic
coverage, and details such as the number of
cleanings covered in a year. Click
here to review an online summary of your coverage.
You'll need to enter in
the social security/ID number and last name
of the primary enrollee to access your records.
(DeltaCare
enrollees: Please
call (800) 422-4234 as online summaries
are not yet available.)
Your
Evidence of Coverage (EOC)
booklet is also an excellent reference about
your dental plan. Offered to every client, this
booklet includes information on benefits, contract
limitations and exclusions. If you don't already
have a copy of your EOC booklet (either a paper
copy or on your company's intranet site), please
contact your employer.
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Why isn't my eligibility information available on your web site? I have completed my enrollment form.
Online benefits and eligibility information is available after your group's effective date. Please check with your employer for verification.
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How will I get reimbursed?
If you visit a Delta dentist,
you are not obligated to pay the entire bill
and wait for reimbursement from Delta. Instead,
Delta pays its portion directly to your dentist.
We send you a Notice of Payment
explaining your portion of the bill. You pay
the dentist only that amount. If you visit a
non-Delta dentist, you may be responsible for
paying the entire bill in advance and waiting
for reimbursement, so it's to your advantage
to select a Delta dentist.
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My
dentist says I need three crowns and it sounds
like it will be pretty expensive. Do I need to
get preapproval from Delta?
A few Delta plans require
preapproval for treatment expected to exceed
$200-$300. However, regardless whether your
plan requires it, it is a good idea to know
exactly what your share of the cost will be
before you receive treatment.
Delta can give you a free estimate,
called a "predetermination,"
based on your records and your dentist's proposed
treatment plan. Delta will review your x-rays,
diagnosis and coverage, and send a statement
back to your dentist detailing what Delta will
pay, and what your costs will be.
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Do Delta's plans cover cosmetic dentistry and orthodontics?
These types of procedures would be covered if your employer purchases these benefits, which are in addition to the comprehensive benefits already included in our dental plans. To determine whether your benefits include these procedures, check with your benefits administrator or your Evidence of Coverage booklet.
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I
am covered by Delta both through my own employer
and my spouse's. Does this mean I now get four
cleanings a year instead of two?
Having two dental plans
(called "dual
coverage")does
not "double" your coverage. However,
it may mean that you will pay lower out-of-pocket
costs.
One plan will be considered
primary (the one through your work), and the
other will be secondary (the one through your
spouse's job). If you have children, primary
coverage for them is usually determined by the
parent whose birthday (month and day, not year)
comes earlier in the year.
Say both you and your
spouse's dental plans cover 80 percent for cleanings.
Usually, your plan would cover the first 80
percent, and your spouse's plan would cover
the remaining 20 percent.
But your spouse's plan
may have a non-duplication of benefits rule.
This means the second plan would pay only if
the first plan paid less than the second would
have paid. In this case, the total benefit would
be limited to 80 percent. You are responsible
for paying the remainder.
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What
if I need dental care while I'm out of the country?
You can see any licensed
dentist, anywhere in the world for dental services.
If you are out of the country and an emergency
occurs, you should seek treatment immediately.
Pay the dentist for the services rendered at
that time. Be sure to ask for a detailed billing
statement that includes: treatment provided,
tooth number, date of service and amount of
service. If possible, have the billing statement
translated into English. This helps us to process
your claim in a timely manner. The currency
is converted by Delta.
When you return home, forward that statement
to Delta, attached to a claim form. Click here
for instructions on completing the form.
Please check with your benefits administrator or your Evidence of Coverage booklet.
What
if I am unhappy with the dental care I received?
All Delta dentists are required
to meet professionally recognized standards
for the quality of their services. If you are
unhappy with the care you received from a Delta
dentist, Delta can arrange for you to be examined
by one of our consulting dentists in your area.
If the consultant finds that the work was faulty,
Delta will ensure that the original dentist
either corrects the work at no additional cost
or grants a refund. In that case, you're free
to choose another dentist to have the treatment
corrected.
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