Delta Dental

Your dental benefits are administered by Delta Dental of Missouri (DDMO), a not-for-profit corporation. DDMO is a member of a nationwide system of dental benefits providers, known as Delta Dental Plans Association (DDPA), the largest provider of dental benefits in America. You may visit the dentist of your choice and select any dentist on a treatment by treatment basis. It is important to remember your out-of-pocket costs may vary depending on your choice.

 

Plan Type: PPO Premier
Group Number: 2108
Phone: 800.335.8266
Web: deltadentalsc.com
Eligibility: Active employees working 30 or more hours per week
Effective Date: 1st of the month after 30 days of continuous employment

Delta Dental has the largest provider of dental benefits in America. This plan offers comprehensive dental coverage, the freedom to select your own dentist, convenient access to quality dental care and affordable rates. Benefits that help pay for the cost of visits to a dentist for preventive, basic, major and orthodontic services.

Delta Dental PPOServicesDelta Dental PPODelta Dental PremierNon- Participating Providers
Contract Year DeductibleApplied to Basic and Major services$50 individual $100 family$50 individual $100 family$50 individual $100 family
Annual MaximumApplied to Preventive, Basic and Major services$1,500$1,500$1,500
Preventive ServicesOral examinations, twice per benefit period Bitewing x-rays, two sets per benefit period Full mouth x-rays, once in any 36 months Periapical x-rays, as required Prophylaxis (cleanings), twice in any benefit period Topical fluoride treatments for dependent children under age 19, twice per benefit period Emergency palliative treatment Space maintainers under age 19, as required Sealants for dependent children under age 16, as required Oral examinations, twice per benefit period Bitewing x-rays, two sets per benefit period Full mouth x-rays, once in any 36 months Periapical x-rays, as required Prophylaxis (cleanings), twice in any benefit period Topical fluoride treatments for dependent children under age 19, twice per benefit period Emergency palliative treatment Space maintainers under age 19, as required Sealants for dependent children under age 16, as required100%100%100%
Basic ServicesFillings Composite fillings covered on all teeth Non-Surgical Periodontics Surgical Periodontics Endodontics Simple extractions Surgical extractions General anesthesia Oral surgery (excluding extractions) Periodontal Maintenance, four in any benefit period (subject to your prophylaxis frequency limitation)80%80%80%
Major ServicesBridges & dentures, once in five years Crowns, Inlays, Onlays once in five years50%50%50%
OrthodontiaOrthodontia for dependent children under age 1950% up to $1,500 lifetime maximum No deductible50% up to $1,500 lifetime maximum No deductible50% up to $1,500 lifetime maximum No deductible

QuestionAnswer
Will I receive a Delta Dental identification card?Yes! You will receive a Delta Dental identification card within 7-10 Business days. When you (or a covered family member) receive dental care, simply present your card to the dentist’s office. Delta Dental dentists will file the claim for you. Please remind your dentist that your dental program is with Delta Dental of South Carolina – the address is on the reverse side of the identification card.
May I go to any dentist?Yes, you may go to the dentist of your choice. However, we encourage you to choose a Delta Dental PPO Network dentist so that you will receive the deepest discounts and maximize your benefits from the EVENING POST INDUSTRIES dental plan. Delta Dental PPO and Premier Network dentists will handle the paperwork for You.
If the dentist I choose is not in either Delta Dental network, how will benefits be paid?If your dentist is not in either Delta Dental network, benefits will be paid up to the submitted amount or the maximum non-network fee allowed per procedure. The benefit payment will be made directly to the dentist's office and the dentist’s office will bill you for all charges not covered by the plan.
How do I know if my dentist participates in one of Delta Dental’s networks?There are several ways to determine if your dentist is in a Delta Dental network, or, if you don’t have a regular dentist, to find a Delta Dental participating dentist in your area: Visit Delta Dental’s website at https://www.deltadentalsc.com/and select “Looking for a Dentist”. Choose Delta Dental PPO or Premier, and locate a list of dentists by zip code or a specific dentist by name. Call Delta Dental at 1-800-335-8266 to request a dentist directory. Simply ask your dentist if he or she is in the Delta Dental PPO or Premier networks.
If my dentist does not participate with Delta Dental, and I do not want to change dentists, will my dental services still be covered?Certainly! You are eligible for benefits even if your dentist does not participate in a Delta Dental network. However, you may have to file a claim for dental benefits yourself and the benefit payment will be sent directly to you by Delta Dental – the payment will not be made to your dentist. The benefit payment for each service is based on the amount charged by the majority of dentists – also referred to as the prevailing fee. If the dentist’s fee is higher than the prevailing fee, the patient is responsible for the balance, in addition to the deductible, coinsurance and any non-covered charges. Your out-of-pocket costs will be more if you do not use a Delta Dental network dentist
Will Delta Dental provide a benefit “predetermination” before I receive extensive dental Treatment?“Predetermination” is the process of reviewing a dental treatment plan and identifying the eligible benefits prior to the services being rendered. Delta Dental recommends (it is not required) that you receive a predetermination of benefits for any proposed dental treatment in excess of $200. Delta Dental’s participating dentists are very familiar with this process and will gladly submit the predetermination documents for you. If you use a non-participating dentist, simply ask the dentist to forward a copy of the treatment plan to Delta Dental of South Carolina. Our customer service department is available to answer any questions about benefit predetermination.
Where can I get a claim form and how do I file a claim to receive benefits?You will not need a claim form if you visit a Delta Dental dentist. If you visit a non-network dentist, Delta Dental will accept any standard American Dental Association (ADA) claim form that details the services and treatment provided – a special claim form is NOT NECESSARY. However, a claim form is available on Delta Dental’s website https://www.deltadentalsc.com/ by selecting Subscribers, then My Benefits, then selecting Claim Form.
How do I contact Delta Dental if I have questions?Delta Dental’s nationwide toll-free number 1-800-335-8266 is listed on the ID card. Customer service is available Monday through Friday from 8 a.m. until 6 p.m. Eastern time. Experienced representatives are able to answer over 99 percent of all questions during the initial phone conversation. If your question requires further research, the customer service representative will call you back within one business day with either a response or an update on the progress made. Delta Dental’s toll free number will also take you to the automated response system that provides eligibility, benefits, claims status and a means to request a dentist directory 24 hours a day, 7 days a week. You may also e-mail questions to Delta Dental’s customer service team at service@ddpmo.org or visit the Delta Dental website,https://www.deltadentalsc.com/a– and select “Contact Us.”

 

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Your claims must be filed by the end of the calendar year following the year in which services were rendered. DDMO is not obligated to pay claims submitted after this period. If a claim is denied due to a PPO or Premier participating dentist’s failure to make timely submission, you will not be liable to such dentist for the amount which would have been payable by DDMO, provided you advised the dentist of your eligibility for benefits at the time of treatment. You will be provided written notice if your claim for benefits under the Plan has been denied, setting forth the specific reasons for such denial, written in a manner to be understood by you. Additionally, if your claim for benefits has been denied, you will be afforded a reasonable opportunity for full review of the decision denying the claim, including appeals and requests for review. Within 180 days after receiving the denial, you may submit a written request for reconsideration of the claim to the Appeals Committee for DDMO. Any such request should be accompanied by documents or records in support of the appeal. You may review pertinent documents relating to the claim and submit issues and comments in writing for consideration by the Appeals Committee. The Committee will review your appeal and will notify you in writing of the decision within 60 days after your appeal is received. In the case of an appeal involving medical judgment, DDMO will consult with a health care professional who has training and experience in the field involved in the medical judgment. The consultant will be an individual who is neither an individual who was consulted in connection with the initial denial, nor the subordinate of any such individual. DDMO will identify the consultant whose advice was obtained on behalf of the Plan, without regard to whether the advice was relied upon in making the benefit determination. Any request for reconsideration should be sent to:   Delta Dental of Missouri Appeals Committee 12399 Gravois Rd. St. Louis, Missouri 63127-1702

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It is important that you take steps to educate yourself on all employee benefit plan options and rewards. It is your responsibility to complete your benefits election in Ultipro, no later than 30 days from eligibility.