This guide is designed to help you get the most from your dental plan. It highlights the key things you need to know as an enrollee. This information is intended to answer general questions you may have about your Covered Benefits and is not specific to each employer group’s coverage. For information specific to your employer’s group coverage, please consult with your HR Manager.

For more information, please click on the links below:

How to Contact Us
How to Use Your Benefits
Eligible Dependents
Visiting the Dentist
Understanding the Delta Dental Networks
Pre-determination of Benefits
Filing Claims
Complaint and Appeals Procedures
Coordination of Benefits
Common Dental Terminology

FINDING YOUR PLAN INFORMATION ON THE WEB
We encourage you to register to use Spotlight - our secured information center. Once registered, you can review benefits and eligibility information, specifics on any claims filed and remaining benefit balances for all the individuals covered under your policy. You can also print additional copies of your ID card to use when visiting your dentist. IMPORTANT: Members are unable to view claims for any one on the plan over the age of 18. Individuals over 18 including spouse should register with their own social security number, user name, and password.

CONTACT US BY PHONE
Call Delta Dental of Oklahoma if you have a question about your dental plan. You can reach us by calling 405-607-2100 (OKC Metro) or 800-522-0188 (toll free). Customer Service representatives are available Monday through Friday - 7:30 am to 5:00 pm to help with:

• General questions
• Claims questions
• Information about network dentists and specialists
• Complaints and problem resolution

Delta Dental also offers a 24-hour automated phone system which can be used to:

Check the status of a claim

Order a New ID Card

Locate a provider

Get updates on available benefits

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You are covered for dental services when enrolled in one of Delta Dental’s plans. Our plans are designed to make Covered Benefits more affordable. In most cases, this plan will pay a portion of the cost of your Covered Benefits (up to any plan maximums). You may be responsible for deductibles, coinsurance and in some cases, dentists charges that exceed what Delta Dental covers. Please see your schedule of benefits for more details about what is covered under your plan. In most cases where you choose to have a more expensive service or benefit than is normally provided, Delta Dental will pay the applicable percentage of the fee for the service which is adequate to restore the tooth or dental arch to proper function. You may be responsible for the difference between what Delta Dental pays and the dentist’s fee for the optional treatment.
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An employee’s spouse and unmarried, dependent children (please see your Schedule of Benefits for details on the dependent age limits) are eligible to be covered under your plan. If you need to add dependents to your coverage, please see your benefit administrator. Generally, dependents can be added to your coverage on the first day of the month immediately following a Qualifying Event as long as Delta Dental is notified in writing no later than 30 days after the qualifying event.

For full details regarding eligibility please refer to your Summary Plan Description (SPD) or contact your Human Resources Department. You may also contact us at the toll-free number on your ID card.
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You may choose to go to any licensed dentist when you need dental care. Whatever dentist you choose, you will receive some level of coverage for Covered Benefits. However, there are advantages when you receive treatment from a dentist participating in one of the Delta Dental networks. Please consult Delta Dental’s website for the most up-to-date information on participating dentists or call our Customer Service department at 800-522-0188 or 405-607-2100.
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DELTA DENTAL PREMIER PLANS
If you are enrolled in a Delta Dental Premier plan, to receive the highest level of benefits you should choose a dentist who participates in the Delta Dental Premier Network. These dentists participate in our largest network and also reduce your out-of-pocket costs by agreeing to accept our Delta Dental Premier Plan Allowance as full payment for Covered Benefits. You will be responsible for any deductible and co-insurance due at the time of service. There is absolutely no balance billing. We pay the dentist directly, so you do not have to pay the whole bill up front and wait for reimbursement.

Of course, as stated earlier, you may select any licensed dentist to provide your dental care. For Covered Benefits provided by non-participating dentists, our payment is based on the Plan Allowance for non-participating dentists, which may be lower than the Delta Dental Premier Plan Allowance. Non-participating dentists have not agreed to accept our discounted reimbursement as payment in full. Meaning that in addition to what Delta Dental pays, you must pay any deductible, co-insurance, and the difference between our non-participating dentist allowance and the charges submitted by this dentist. Therefore, the amount you would owe a non-participating dentist is typically higher than if you chose a Delta Dental Premier dentist. If you do decide on a non-participating dentist, in most cases, we will pay you directly for Covered Benefits unless an assignment of benefits is made with Delta Dental.

DELTA DENTAL PPO PLANS*
If your plan is a PPO plan, you can enjoy the ultimate balance of cost and flexibility. Just choose a dentist who participates in the Delta Dental PPO network, and you will receive the greatest level of savings on your out-of-pocket costs. PPO dentists have agreed to accept a greater discount (The Delta Dental PPO Plan Allowance) as payment in full for covered procedures. This means that you only pay your deductible and any co-insurance for Covered Benefits. We pay PPO dentists directly, so you do not have to pay the whole bill up front and wait for reimbursement.

Of course, as stated earlier, you may select any licensed dentist to provide your dental care. For Covered Benefits provided by non-participating dentists, our payment is based on the Delta Dental PPO Plan Allowance. Non-participating and Delta Dental Premier dentists have not agreed to accept our discounted PPO Plan Allowance as payment in full. This means that in addition to what Delta Dental pays, you must pay any deductible and co-insurance. For a non-participating dentist you may also have to pay the difference between our Delta Dental PPO Plan Allowance and the charges submitted by this dentist. For a Delta Dental Premier dentist you must also pay the difference between our Delta Dental PPO Plan Allowance and Delta Dental Premier Plan Allowance. Therefore, the amount you would owe a non-participating or Delta Dental Premier Dentist is typically higher than if you chose a Delta Dental PPO dentist. If you go to a non-participating dentist, in most cases, we will pay you directly for Covered Benefits unless an assignment of benefits is made with Delta Dental. We pay PPO dentists directly, so you do not have to pay the whole bill up front and wait for reimbursement.

DELTA DENTAL PPO/PREMIER (COMBINED) PLANS*
With these plans you are provided with a unique opportunity we call the "plus Premier" feature. This feature allows you to select a dentist from either the Delta Dental PPO or the Delta Dental Premier network with no balance-billing. These participating dentists have agreed to accept our Plan Allowance as payment in full for your Covered Benefits. This means that you pay your deductible and any co-insurance for Covered Benefits. We pay the dentist directly, so you do not have to pay the whole bill up front and wait for reimbursement.

Of course, as stated earlier, you may select any licensed dentist to provide your dental care. For Covered Benefits provided by non-participating dentists, our payment is based on the Delta Dental PPO Plan Allowance. Non-participating dentists have not agreed to accept our discounted PPO Plan Allowance as payment in full. This means that in addition to what Delta Dental pays, you must pay any deductible and co-insurance. In addition, for a non-participating dentist you must also pay the difference between our non-participating dentist allowance and the charges submitted by this dentist. Therefore, the amount you would owe a non-participating is typically higher than if you chose a Delta Dental PPO or Delta Dental Premier Dentist. If you go to a non-participating dentist, in most cases, we will pay you directly for Covered Benefits unless an assignment of benefits is made with Delta Dental. We pay PPO dentists directly, so you do not have to pay the whole bill up front and wait for reimbursement.
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Another aspect of Delta Dental’s quality assurance is cost management. It’s a responsibility we have to you, our customer. To fulfill that responsibility, we’re tracking and analyzing costs at every step of the process. Delta Dental’s close relationship with our participating dentists goes along way toward achieving cost-conscious coverage for you.

To assist you in managing your total costs, Delta Dental also offers what's called "Pre-determination of Benefits". Dentists may submit their treatment plan to Delta Dental for review and estimation of coverage before procedures are started. Delta Dental advises the patient and the dentist of what services are covered and what the payment would be. The actual payment for these pre-determined services depends on eligibility, any plan limitations, coordination of benefits and the remaining maximum at the time services are performed. A pre-determination plan is subject to change based on the dentist’s participation status at the time of treatment and does not guarantee direct payment. A predetermination plan is valid for 90 days once issued. Of course, pre-determination is optional, but it is strongly recommended for dental services expected to exceed $250. Once the service is completed, the claim should be submitted to Delta Dental for prompt payment.
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Most dentists file claims electronically or have claim forms on hand. If they don’t, you may obtain one by visiting the Forms and Links portion of our website. In some cases your human resources office may have a supply, or you can call Customer Service at 800-522-0188 or 405-607-2100.

If you use a Delta Dental participating dentist, your claim will be submitted for you. If you visit a non-participating dentist, you may need to submit your own claim. Just follow these easy steps to ensure efficient processing:

Complete your portion of the claim form and present the form to the dentist for completion. If you visit a non-participating dentist you may need to mail your completed claim form to the address below. Delta Dental will notify you in writing of the amount of benefits which are paid on your behalf and the amount which you must pay. This is called a Explanation of Benefits.

All claims must be submitted within twelve (12) months of the date services are completed. This is called the timely filing limitation. If the claim is for Orthodontic services, the claim should be filed at the time of the banding. For new enrollee’s who are already in Orthodontic treatment when this coverage becomes effective or after a Benefit Waiting Period (if applicable) is met, should file a claim upon enrollment or once the Benefit Waiting Period has been satisfied.
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You have the right to file a complaint or a claim. Please consult the SPD section at the end of your handbook for details.
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If you are covered under another dental plan, Delta Dental will coordinate your Covered Benefits as described in your SPD. Among other things, Coordination of Benefits eliminates duplicate payments for the same Dental or Orthodontic services. Please see the SPD handbook for details on the rules regarding which insurance plan would be considered primary and which would be considered secondary for payment purposes.
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Click here for a list of definitions for commonly used dental terms.