Individual & Family Dental Plan Frequently Asked Questions
We know that you have questions when making decisions on dental coverage. We have answers. We've assembled a set of frequently asked dental insurance-related questions to help you get the answers you need quickly.
Should you have questions that are not answered here, please contact us. We strive to answer every inquiry quickly and accurately.
How can I learn more about your new individual and family plans?
View the following videos that give an overview of the coverage with each plan:
Is this insurance?
Yes.
How do I pay Delta Dental for my dental coverage?
If you choose monthly payments, premiums will be automatically withdrawn from the credit card or checking account you enter when you enroll. Members paying annually also have the option to pay with a personal check.
What payment methods do you accept?
You can pay by check or bank draft. We also accept the following credit cards: VISA, American Express, Mastercard and Discover.
What is not covered?
Download the brochures below for more information on covered services, exclusions and limitations.
Are there waiting periods?
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. 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.
Will there be a deductible?
Download the brochures below for more information on plan deductibles.
Is orthodontia covered?
EHB-Certified Plans:
For 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. For individuals under the age of 19, medically necessary orthodontics are covered at 50 percent. Medically necessary orthodontics is a key element of the Pediatric Dental Essential Health Benefit required under the Affordable Care Act. 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. To qualify for medically necessary orthodontic coverage, your child’s condition must be evaluated by a dentist. An orthodontic evaluation will help you determine whether your child will qualify for medically necessary orthodontic services. Prior authorization is required before you obtain any treatment. 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.
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. 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. You and your dentist will be notified in writing of our decision to approve or deny coverage for the treatment. You can access our Medically Necessary Orthodontics Guidelines HERE.
Non-EHB Plans:
Orthodontia is covered 50% with the Premium Plan. For full details, download the plan brochure HERE.
What is the annual maximum?
Download the brochures below for more information on plan annual maximums.
Is tooth whitening covered?
Tooth whitening is not covered.
Are implants covered?
EHB-Certified Plans:
Implants are not a covered benefit under these plans for individuals 19 years of age and older.
Non-EHB Plans:
Implants are covered at up to 50% with the Enhanced Plan and the Premium Plan. View full plan details HERE.
Are white/composite fillings covered?
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.
How long is my policy in effect?
The initial coverage period is 12 months.
If necessary, can I cancel my policy?
Yes, this policy can be canceled by submitting a written cancellation request, as indicated in your policy. Delta Dental will refund any premium paid, but not yet earned due to policy cancellation. The refund will be based on the number of full months that remain in the 12-month policy period.
*if you purchased your individual dental policy on healthcare.gov please call 800-223-3104 for all questions regarding your policy.
Are benefits paid on a contract year or calendar year?
Benefits are paid on a calendar year basis, regardless of the effective date or contract renewal date.
Once I have submitted my application, what is the next step?
Soon after you have enrolled, you will receive a member packet from Delta Dental that includes your identification card and detailed benefit information.
Where can I send Individual and Family plan paper claims, if needed?
Delta Dental
PO Box 9085
Farmington Hills, MI 48333-9085