DeltaCare USA® Plan Disclosures
- If you are in the state of WY, you do not need to select a primary care dental facility, but you must visit a DeltaCare USA dentist to receive benefits. If you're in any of the following states, you do not need to select a primary care facility, and you can maximize your savings when you visit a DeltaCare USA dentist, although you may visit any licensed dentist and receive out-of-network coverage: AK, CT, LA, ME, MS, MT, NC, ND, NH, OK, SD, VT. If you're in the state of ID, you do need to select a primary care facility, and, while you can maximize your savings when you visit a DeltaCare USA dentist, you may visit any licensed general dentist and receive out-of-network coverage. Refer to your plan booklet for details about out-of-network benefits.
- The number of covered procedures varies by plan.
- Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. In the following states, you can change your dentist any time without contacting Delta Dental: AK, CT, LA, ME, MS, MT, NC, ND, NH, OK, SD, VT, WY.
- You may have to complete a claim form if you visit an out-of-network dentist, such as for limited emergency treatment or if you live in the following states: AK, CT, ID, LA, ME, MS, MT, NC, ND, NH, OK, SD, VT.
- In MA, you cannot select more than three primary care dental facilities per family.
- In TX, three weeks is a reasonable amount of time to wait for a routine, non-urgent appointment.
DeltaCare USA is underwritten in these states by these entities: AL - Alpha Dental of Alabama, Inc.; AZ - Alpha Dental of Arizona, Inc.; CA - Delta Dental of California; AR, CO, IA, MA, ME, MI, MN, NC, ND, NE, NH, OK, OR, RI, SC, SD, VT, WA, WI, WY - Dentegra Insurance Company; AK, CT, DC, DE, FL, GA, KS, LA, MS, MT, TN, WV - Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX - Alpha Dental Programs, Inc.; NV - Alpha Dental of Nevada, Inc.; UT - Alpha Dental of Utah, Inc.; NM - Alpha Dental of New Mexico, Inc.; NY - Delta Dental of New York, Inc.; PA - Delta Dental of Pennsylvania; VA - Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products.
(Delta Dental is a registered trademark of Delta Dental Plans Association.