FAQ

Frequently Asked Questions

Click the question to open and close the Q and A below.

HMO Vs PPO

When it comes to dental health plans, you want benefits that fit the needs of you and your family. Each of Delta Dental’s PPO and HMO plans offers comprehensive dental coverage while retaining quality care and excellent customer service. Each plan has its own advantages.

It comes down to cost versus choice. Our PPO plan gives you the widest selection of dentists though you may have higher out-of-pocket costs.

With our HMO plan, you may have lower out-of-pocket costs, but your choice of dentist is more limited

HMO

A HMO is a closed network plan that features set copayments, no annual deductibles and no maximums for covered benefits.

  • What this means for you is that you must have a set Primary Dentist that accepts Delta Dental
  • All covered procedures have predetermined copayments (this means out-of-pocket costs are predictable)
  • No annual deductible and no annual dollar maximums on general services
  • No waiting Periods meaning you can get work done the day your plan becomes effective
  • With an HMO plan you will need to get a refferal from your primary Dentist to see a specialist

PPO

PPO plans allow you to select any licensed dentist. We recommend you select a Delta Dental dentist because you may enjoy lower out-of-pocket costs.

  • No need to preregister with a dental office, Even if your Dentist isnt a Dental PPO Dentist, you can still use your Dentist.
  • Covered services paid at applicable percentage (for example, 80%)
  • PPO plans often have annual deductibles and annual maximums
  • The PPO plan can be used immediately for dentist visits and cleanings, but there will be a 6 mth waiting period for other work. The term “Waiting Period” means the time that must pass before your benefits begin under a dental plan.
  • No referral required for specialty care
A Copay is payment made by a beneficiary in addition to that made by an insurer. So this would be your out of pocket cost for a procedure.
When you enroll you you agree to keep the coverage for 6 mths, since this is the normal amount of time it would take to get your procedures taken care of and all bills resolved.
You can keep your Delta Dental plan as long as you need it. If a Dependant reaches the age of 26 they will need to get a seperate delta dental plan.
For the Classic and Premium PPO Plans, you can use any dentist in our Delta Dental Premier® or Delta Dental PPOSM networks. You can also use a non-participating dentist, but you will likely have more out-of-pocket expense if you do so. For the HMO Plans, you can use any dentist in our Delta Dental network, if you choose to see a Dentist outside of the network there is no coverage for services rendered by non-participating dentists. Delta Dental has a large network of participating dentist nationwide, so there is a good chance that your dentist is in the network. You can obtain a list of participating dentists from by checking our provider search or by calling 1-800-396-7683.
Our dentist search tool allows you to search for dentists in your area by address or zip code. You'll need to know which network(s) your plan allows access to in order to search. Our tool also gives you the option to search by additional criteria such as dentist or practice name, specialty, languages spoken, gender and hours of service. If you need assistance you can give our customer service a call at 1 800-396-7683 and we will be happy to assist you.

Provider Search

If You are enrolled in a Delta HMO Plan:

For your convenience you will have no need for a ID card you will be registered with your dentist and they will already have your information! However you may call customer service at 1 800-396-7683 if you wish you request an id card.

If you are enrolled in a Delta PPO Plan:

Your Delta Dental id card will arrive on or around your effective date which will normally be on the 1st of a month, if you have any questions or concerns about receiveing your card please feel free to give us a call at 1 800-396-7683.
You may at anytime add a Spouse or family member to your Delta Dental plan as long as they meet the requirements to be on the plan. Their Coverage would be active on the 1st of the following month as long as the request is placed before the 15th of the month. You may add as many dependents as needed as long as they meet the age requirements.
To remove someone or change your plan level our customer serive will be able to assit you with this just give us a call at 1 800-396-7683
  • Delta Dental PPO

    • Enrollees can visit any licensed dentist in the country — or the world. You will usually save money on out-of-pocket costs when you choose a Delta Dental PPO dentist. The Delta Dental Premier network, which includes more than 80% of dentists nationwide,† also offers cost-saving features. Locate a PPO or Premier dentist at deltadentalins.com.
    • Outside the U.S.

    • When you’re traveling abroad, access savings for needed dental care through your out-of-network benefits. Refer to your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for information about your plan’s benefits, as well as any exclusions or limitations.
  • Delta Dental HMO

    • DeltaCare USA enrollees must receive standard treatment from their selected network dentist, but a limited allowance is available for out-of-area emergency care. In some states, DeltaCare USA is offered as an open access plan where enrollees can obtain treatment from any licensed dentist; however, deductibles and maximums may be applied for services provided by an out-of-network dentist. Refer to your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for more information.
    • Payment and claims information If you visit an out-of-network dentist, you are responsible for paying for your treatment at the time of service
Some dental plans have a specific dollar deductible. It works like your car insurance. During a benefit period, you personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Your plan information will describe how your deductible works. Plans do vary on this point. For instance, some dental plans will apply the deductible to diagnostic or preventive treatments, and others will not. Not all Dental plans have a deductible. To Find out if your plan has a deductible feel free to contact us at 1-800-396-7683
Your Dental premium will not change once you enroll you will be locked in at your rate. The only exception would be if you were to change your plan or add more family members to your plan.
If you wish to change your dentist or you need assistant you can just give our customer service a call at 1 800-396-7683 and we will be happy to assist you.
Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits. Allowances for some procedures covered under your benefits may be subject to limitation or denial based upon clinical criteria applied by Delta Dental’s licensed dentist consultant staff. We maintain written guidelines for the use of clinical criteria in making benefit determinations. You may obtain a copy of such guidelines for:
  • Basic benefits
  • Crowns, inlays, onlays and cast restoration benefits
  • Prosthodontic benefits
For any questions on your limitations and exclusions just give our customer service a call at 1 800-396-7683 and we will be happy to assist you.

NAFMD Dental Banner

Do You Need Dental Coverage? Give us a call if you have any questions! Taking good care of your mouth does more than help ensure you have a bright, white smile. Having a healthy mouth and healthy body go hand-in-hand! Let us help you Understand the meaning of "healthy mouth, healthy you"!

100% Satisfaction
Godaddy Secure
Secure SSL