Frequently Asked Questions


Frequently Asked Questions Find answers to your questions about our products, services, capabilities and much more. The Cost of Dental Care: What are your rates? What does Delta Dental pay for different services? Do I need approval for major work? What happens when I am covered by two dental Plans? Selecting a Dentist: How do I know if my dentist is a Delta Dental dentist? What are the advantages of visiting a Delta Dental dentist? My dentist is not a Delta Dental dentist. Can I still visit him or her? How do I change dentists? Paperwork: Do I need to add new dependents to my family coverage? Where can I submit a change of address? How do I add my new spouse to my plan? Where can I get claim forms? About Delta Dental: Is there a minimum number of employees that have to enroll in order for Delta Dental to issue a dental plan? Why does Delta Dental have minimum enrollment requirements on its group dental plans? Does Delta Dental require an employee work a minimum number of hours to be eligible for coverage under a Delta Dental group dental plan? What is open enrollment? What is a late enrollee? Does open enrollment eliminate late enrollee provisions? Can I change my contract? More Questions? Call 1-800-522-0188 or 405-607-2100 and ask for our Customer Service Department. THE COST OF DENTAL CARE Q. What are your rates? I am trying to figure out how much a dental plan from Delta Dental of Oklahoma will cost me. Do you have a page showing how much I will pay and what the coverage will be? A. Unfortunately, no. Dental programs from Delta Dental of Oklahoma are purchased by employers and other groups, and the coverage and costs will vary according to the requirements and characteristics of each group. For example, an employer based in an area with high dental costs may desire to cover a higher percentage of dental services and want the maximum freedom of choice for employees in selecting dentists. Another company might be looking for lower costs by selecting a plan with lower benefits, but one which will still provide basic dental care for employees. Delta Dental underwriters also consider factors like a group's past dental insurance history, type of business, etc., before quoting a rate. We do offer a dental program for small business employers (2-9 full-time employees) that offers a set coverage level and set rates. You can get additional information and pricing on our Small Business Plans by writing to marketing@deltadentalok.org. return to questions Q. What does Delta Dental pay for different services? I have Delta Dental coverage through my employer and I am trying to figure out how much Delta Dental will pay for different services. A. The best thing to do is ask your dentist, who has easy access to your individual coverage information. Many patients are reluctant to ask their dentist for this information, but your dental office will probably welcome the opportunity for a frank discussion of fees and what your share of the cost will be. Delta Dental’s payment will vary depending on: • The dentist you select All Delta Dental of Oklahoma programs allow you to choose any dentist. Under most Delta Dental programs you will have a certain percentage of coverage (for example, 100 percent coverage for diagnostic and preventive services such as examinations, cleanings, and x-rays). The coverage will always be 100 percent up to the maximum allowable, as long as you visit a participating Delta Dental dentist. • The program you are enrolled in Some Delta Dental programs, usually our Delta Dental Premier programs, cover a certain percentage of the allowable fee for each procedure, up to your annual maximum benefit payment. You pay the difference between the allowable fee and the payment made by Delta Dental. Some Delta Dental programs, usually our Delta's Choice programs, specify the dollar amount you pay for each covered service. You receive a list of the covered services and your co-payments (the amount you are responsible for paying). To better understand your Delta Dental coverage, review the materials you received after you were enrolled. You may also call Delta Dental of Oklahoma's customer service department with specific benefit questions. If you live in the Oklahoma City metropolitan area, call 405-607-2100 and ask for Customer Service. If you reside outside the Oklahoma City metropolitan area, call toll-free at 1-800-522-0188 return to questions Q. Do I need pre-approval for major work? My dentist says I need three crowns and it sounds like it will be pretty expensive. A. Most Delta Dental programs do not require pre-approval for treatment. However, whether or not your program requires it, it is a good idea to know that the treatment proposed is covered under your dental plan and exactly what your share of the cost will be before you receive treatment. Delta Dental can provide your dentist with a free estimate, called a "predetermination of benefits", based on your records and your dentist’s proposed treatment. Delta Dental will review your x-rays, diagnosis, and coverage and send a statement back to your dentist detailing what Delta Dental will pay and what your costs will be. return to questions Q. What happens when I am covered by two dental plans? Does this mean I now get four cleanings a year instead of two? A. Having two dental programs (called "dual coverage") does not "double" your coverage. However, it may mean that you will pay lower out-of-pocket costs. One program will be considered primary (the one that usually covers you as an employee) and the other will be secondary (the one that typically covers you as a dependent). If you have children covered the primary plan is usually the one that covers the parent whose birthday falls first in the calendar year (month and day—not year). For example, if your spouse’s birthday is March 13 and your birthday is June 27, your spouse’s program is the primary for the children. When a person has coverage through two carriers, benefits are coordinated by the two carriers so the person gets the maximum benefit from both plans, but not to exceed 100 percent of the total charge. Claims should first be submitted to the primary for payment. If the charges are not paid in full by the primary plan, the claim should then be submitted to the secondary for possible additional payment on the charges. Some dental programs may have a nonduplication of benefits rule. This means the secondary plan would pay only if the primary plan paid less than the secondary plan would have paid had it been the primary plan. In this case, the total benefit would be limited to the payment made by the primary plan. You are responsible for paying the remainder. After your enrollment register for Spotlight™ to access your dental benefits and so much more. return to questions SELECTING A DENTIST Q. How do I know if my dentist is a Delta Dental dentist? A. About 85 percent of Oklahoma’s dentists and about two-thirds of the nation’s dentists are Delta Dental participating dentists, so there is a good chance that your dentist is too. You can ask your dentist if he or she is a Delta Dental participating dentist, or you can check the Dentist Directory on our web site. Please identify the type of plan you are enrolled in to identify the appropriate dentist to help you maximize your benefits. return to questions Q. What are the advantages of visiting a Delta Dental participating dentist? A. When you visit a Delta Dental participating dentist: You do not pay the entire bill and wait for reimbursement from Delta Dental. Instead, Delta Dental pays its portion of the cost directly to your dentist. We send you a notice explaining your portion of the bill (an Explanation of Benefits). You pay the dentist only that amount. Delta Dental makes sure you are not charged extra for services that should be included in the cost of treatment. For example, when you receive a crown, you cannot be charged additional fees for tooth preparation, local anesthesia, an impression, or a temporary crown. The dentist handles all claim forms and other paperwork for you. return to questions Q. My dentist is not a Delta Dental dentist. Can I still visit him or her? A. Delta Dental programs allow you to select any licensed dentist. While we recommend you select a Delta Dental participating dentist because you may enjoy lower out-of-pocket costs and the convenience of having your claim forms handled free-of-charge by the dental office, you are free to choose any dentist. If your dentist is not a Delta Dental participating dentist, encourage him or her to become one. In addition, you may furnish your dentist’s name and address to Delta Dental of Oklahoma’s Customer Service department. If you live in the Oklahoma City metropolitan area, call 405-607-2100 and ask for Customer Service. If you reside outside the Oklahoma City metropolitan area, call toll-free at 1-800-522-0188. Our Customer Service department will send your dentist a packet including information and the forms necessary to become a participating dentist. return to questions Q. How do I change dentists? A. Most Delta Dental programs allow you to see any dentist you wish, and there is no need to notify us when you change dentists. You and your family members are also free to see different dentists, if you prefer. return to questions PAPERWORK Q. If I already have family coverage, do I need to add new family members or are they automatically covered? A. Most Delta Dental programs require that if the primary enrollee has family coverage, information for each family member must be included, including newborns (name, sex, date of birth, and relationship to primary enrollee). Therefore, please review and follow the procedures at your company to add, delete, or change information about covered family members, particularly those that pertain to the time limit on making changes. return to questions Q. Where can I submit a change of address? A. Delta Dental receives any change of address you make through your Human Resources Department at your place of employment. Make sure your Human Resources manager is notified with the updated address change, and Delta Dental should automatically receive it from them. You should also notify your dentist. Delta Dental mails the Explanation of Benefits (a statement explaining what services the dentist provided, the amounts Delta Dental will pay, and the amount you are responsible for paying) to the primary enrollee, who is the person with the dental coverage. return to questions Q. I have just gotten married. How do I add my new spouse to my plan? A. Delta Dental receives the information about covered family members from your employer or other group sponsor. Please review and follow the procedures at your company to add, delete, or change information about covered family members, particularly those that pertain to the time limit on making changes. return to questions Q. Where can I get claim forms? A. One of the advantages of visiting a Delta Dental participating dentist is you do not need claim forms. Delta Dental participating dentists will take care of all claims paperwork for you. If you go to a non-participating dentist, you may obtain a claim form from your employer's benefits department. Delta Dental will also accept any claim form approved by the American Dental Association. You are responsible for filing your own claims paperwork if treatment is provided by a non-participating dentist. return to questions ABOUT DELTA DENTAL Q. Is there a minimum number of employees that have to enroll in order for Delta Dental to issue a dental plan? A. Delta Dental of Oklahoma issues employer-sponsored group dental plans. Many group plan options are available, but the options available to a particular employer may vary depending on the employer contribution to premium costs (if any), the size of the employee base, etc. Also, a new non-insurance discount dental service called Delta Dental Patient Direct is available to individuals and families, as well as our Delta Dental Premier Insured for Individuals & Families. For information regarding the group plan options available, ask your employer to contact marketing@deltadentalok.org. return to questions Q. Why does Delta Dental have minimum enrollment requirements on its group dental plans? A. In order to offer affordable, competitive premium rates, the claims risk must be spread over a large enough participant base to generate sufficient premium income to cover the cost of claims and administration. Minimum enrollment requirements vary depending on the program type, employer contribution to the premium costs, etc. Check with your employer to find out what the enrollment requirements are under their Delta Dental group dental plan. return to questions Q. Does Delta Dental require an employee work a minimum number of hours in order to be eligible for coverage under a Delta Dental group dental plan? A. Most Delta Dental of Oklahoma group dental plans provide coverage only for full-time employees and those persons eligible for coverage under the provisions of COBRA (when COBRA applies). Although the standard guidelines define a full-time employee as a person regularly scheduled to work 30 or more hours per week, if the employer defines a full-time employee as a person regularly scheduled to work 24 or more hours per week, or 20 or more hours per week, etc., Delta Dental of Oklahoma would consider such person eligible for coverage under the employer's group dental plan. return to questions Q. What is open enrollment? A. Open enrollment is the period of time (as agreed upon by the employer and Delta Dental of Oklahoma) during which changes in an employee's enrollment status may be allowed. For example, an employee with individual coverage changing his/her enrollment status to family coverage, etc. Typically, open enrollment occurs once a year, with the effective date of the enrollment changes being the same as the plan anniversary date. For example, if an employee chose not to enroll his/her eligible dependents at the time he/she enrolled, those dependents may be enrolled during a future open enrollment period. If the group dental plan anniversary date is March 1, enrollment changes requested during the open enrollment period will be effective March 1. If at the employee's hire date they do not add their dependents/spouse and they choose to add them during the open enrollment period, waiting periods will apply. See late enrollee information. return to questions Q. What is a late enrollee? A. Any eligible person failing to enroll or waiving coverage at time of initial eligibility, or any enrolled person who voluntarily discontinues coverage, is considered a "late enrollee" and, as such, subject to limited benefits during the first twelve (12) months covered under the plan. return to questions Q. Does open enrollment eliminate late enrollee provisions? A. Open enrollment does not change any late enrollee provisions in the Agreement between the employer and Delta Dental of Oklahoma. return to questions Q. Can I change my contract? A. Delta Dental of Oklahoma utilizes a standard Plan Agreement for all fully-insured (risk) groups. The contract is approved and on file with the State Department of Insurance. Any request to change the provisions of the contract would require a written request submitted to DDOK's marketing department and review by DDOK's executive management. Depending on the nature of the change requested, the modification of the contract may require approval by the State Department of Insurance, in addition to DDOK approval, before the change is implemented. return to questions