The information below applies to our standard processing policies and contract coverage, and is to be used only as a guide. Your group contract serves as the controlling document of your plan.
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Plan basics
What is DeltaCare USA?
DeltaCare USA is a closed network product* that features set copayments, no annual deductibles and no maximums for covered benefits. Upon enrollment, enrollees will receive a plan booklet with defined copayments for covered services. In most states, enrollees must select a primary care dentist in the DeltaCare USA network in order to receive treatment, as in a traditional HMO.
How does it work?
Enrollees must receive care from their selected/assigned primary care dentist within the DeltaCare USA network. (In most states, if they do not select a primary care dentist, Delta Dental will assign one near the enrollee’s home address.)
How do enrollees pay for services?
At the time of service, enrollees pay the dentist only the listed copayment (found in their plan booklet) for covered services.
Do enrollees need an ID card?
No. Enrollees can simply provide the dentist with their name, date of birth and social security number or enrollee ID to verify coverage, or they can display ID cards from their mobile device by logging in to Online Services.
Finding a dentist
How do enrollees select or change their general dentist?
Enrollees can search for a dentist using the Find a Dentist feature on the right side navigation on deltadentalins.com. Enrollees must enter their location and select the DeltaCare USA network from the drop-down menu. For a more targeted search, enrollees can enter the name of a dentist or dental office. Enrollees can read this flyer1.3 MB for more help on finding a network dentist.
To select or change their assigned general dentist, enrollees must register for Online Services. Once registered, they can use the Find a Dentist feature behind login to make dentist selections or updates. Dentist changes made by the 21st of the month will take effect on the first of the following month.
Do enrollees’ dependents receive treatment from the same primary care dentist?
Family members may select their own DeltaCare USA general dentist in approved states. (States are rated and approved for each group. Refer to your group contract for full details).
Can children visit a pediatric dentist?
Yes, with a referral from the child’s assigned general dentist. However, benefits provided by a pediatric dentist are generally limited to children through age seven following an attempt by the assigned primary dentist to treat the child. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis.
Specialty and emergency care
Is there a provision for emergency care?
Yes. If enrollees cannot reach their network dentist or DeltaCare USA customer service for a referral, they may use their out-of-area emergency benefit (typically limited to $100 per emergency, subject to standard plan limitations and exclusions; copayments may apply). Share this helpful guide with enrollees if they have further questions.
How is specialty care handled?
The primary care dentist coordinates specialty care needs for oral surgery, pediatric dentistry, endodontics or periodontics with a DeltaCare USA network specialist. If there is no network specialist within the service area, a referral to an out-of-network specialist will be authorized at no extra cost, other than applicable copayments.
Pre-existing conditions
Are pre-existing dental conditions and treatment-in-progress covered?
Treatment for pre-existing conditions, such as extracted teeth, is covered under the DeltaCare USA program. However, benefits are not provided for any dental treatment-in-progress started before joining the program (such as teeth prepared for crowns, root canals and impressions for dentures). Orthodontic treatment-in-progress may be covered for new DeltaCare USA enrollees.
Orthodontics
How does the orthodontic treatment-in-progress provision work?
Treatment-in-progress coverage depends on your plan and applies only if enrollees are in active treatment (banding has taken place). Most DeltaCare USA plans allow enrollees to continue treatment started under a previous dental plan. They can visit the same orthodontist, with the same coverage and copayments as their previous plan as long as they remain eligible for coverage under their DeltaCare USA plan.*
Enrollees should download the DeltaCare USA Continuous Orthodontic Coverage form29 KB from the Delta Dental enrollees web page and give it directly to their orthodontist. The orthodontist will complete the form and mail it to our DeltaCare USA Claims department, along with the required supporting documents. The orthodontist can access the form directly from the Provider Tools Reference Library on our website.
How do enrollees begin orthodontic treatment?
To receive orthodontic benefits, enrollees begin by selecting a DeltaCare USA network orthodontist. Their copayments, limitations and exclusions are determined by the group contract.*
How do enrollees find a contracted DeltaCare USA orthodontist?
To find a DeltaCare USA dentist, enrollees can go to Online Services and search for a DeltaCare USA dentist by specialty and location using the Find a Dentist tool. Primary care dentists may be able to help find an orthodontist within the DeltaCare USA network.
What orthodontic services are covered?
The DeltaCare USA program typically covers all types of orthodontics: Limited orthodontics for children and adults, interceptive orthodontics for children and comprehensive orthodontics for children and adults.*
Can enrollees find out how much orthodontic treatment will cost?
All treatment plans are different. Enrollees should obtain a detailed treatment plan with all procedures and costs when visiting their orthodontist for the first time. Enrollees should compare the treatment plan with their benefit booklet and to be sure to ask the orthodontist any questions they have before receiving care.
Is general anesthesia/intravenous sedation covered?
General anesthesia and/or intravenous sedation/analgesia is generally a covered benefit limited to treatment by a contracted oral surgeon and in conjunction with a referral for the removal of one or more partial or full bony impactions. Refer to your group contract to determine if this coverage is included with your plan.
If the orthodontist recommends x-rays, can they be done by the general dentist?
No. All x-rays must be performed by the orthodontist. (Some orthodontists may refer patients to labs specializing in orthodontic x-rays for specific photos.) Enrollees are responsible for the listed copayment.
Does the plan cover extractions for orthodontic purposes?
Most plans cover extractions for orthodontic purposes at the listed copayment. Refer to your group contract to determine if this coverage is included with your plan.
Are Invisalign® or clear braces covered?
Invisalign and other specialty appliances will result in additional fees. Enrollees should obtain an estimate from their orthodontist prior to beginning treatment.
Can enrollees change orthodontists?
No. Once enrollees start treatment they cannot switch orthodontists.
* Your benefits may differ from the general information provided here. Review your group contract for specific details regarding coverage under your plan.