| Current Location: Delta Dental Of North Carolina > Subscribers > Q & A |
|
||
1. What is a dental plan?
2. Do I need my identification (I.D.) card when I get care?
3. What if someone in my family has another dental insurance plan? How does COB (Coordination of Benefits) work?
4. Can I change dentists?
5. How do I know which dentist to select?
6. Do I need to verify that my dentist is a Delta Dental participating dentist?
7. What are the advantages of using a Delta Dental participating dentist?
8. What happens if care is received from a non-participating dentist?
9. What username should I use when signing into the system?
10. Who do I contact with a change of address?
11. How are dental benefits affected if a dependent child is ill or injured and can no longer attend school on a full-time basis?
1. What is a dental plan?
Understanding your dental benefits ensures you get the most appropriate and cost-effective care. We've created an easy-to-read brochure with commonly asked questions and answers to provide you with a clearer understanding of this important benefit.
If you have an I.D. card, please show it to your dentist at each visit so a proper claim can be filed for your dental services. Otherwise, please supply your group name, group number ( if you know it) and your I.D. number/social security number. To find a participating dentist, please use our Dentist Search.
3. What if someone in my family has another dental insurance plan? How does COB (Coordination of Benefits) work?
When someone has additional dental coverage, one plan is usually primary. This means that your dentist sends the claim for service to the primary insurance plan and may also submit it to a secondary plan. Delta Dental will coordinate benefits if a subscriber has coverage under more than one dental plan. Refer to your benefit booklet for your plan's specific provisions.
4. Can I change dentists?
Yes. Requirements for changing dentists vary by plan; refer to your benefit booklet for your plan's specific provisions.
5. How do I know which dentist to select?
Get recommendations from friends, neighbors, co-workers and family subscribers to find a dentist who matches your needs and values. A convenient location and clinic hours, possibly including Saturday and evening hours, may also be important considerations for you.
6. Do I need to verify that my dentist is a Delta Dental participating dentist?
Yes. By checking with your dentist or Delta Dental Customer Service, you are assured that your dentist is still participating in the network. Consult your benefit booklet for more information regarding your specific plan design.
Delta Dental suggests you verify a dentist's participation status with Delta Dental or with your dental office before each dental appointment.
7. What are the advantages of using a Delta Dental participating dentist?
A Delta Dental participating dentist is a dentist who has signed a participating and membership agreement with Delta Dental. The dentist has agreed to accept Delta Dental's allowable charge as payment in full for covered dental care. A participating dentist is not allowed to bill more than Delta Dental's allowable charge. A Delta Dental participating dentist will also file the claim directly with Delta Dental. Delta Dental will make payment directly to the participating dentist and you will receive an explanation of benefits detailing your financial responsibility for any deductible or coinsurance amounts.
8. What happens if care is received from a non-participating dentist?
If dental services are received from a non-participating dentist, reimbursement for the services will be paid directly to you, and you are responsible for paying your dentist. The allowances for services you receive from a non-participating dentist may be significantly less than what Delta Dental would pay a Delta Dental participating dentist. You may share more of the cost of your care and are responsible for the dental charges up to the dentist's full-billed amount.
To find a participating dentist, please use our Dentist Search. Delta Dental suggests you verify a dentist's participation status with Delta Dental or with your dental office before each dental appointment.
9. What username should I use when signing into the system?
Use the username you created during the registration process. Note, the username field is separate from the subscriber I.D. field, which uses your subscriber I.D. or social security number.
10. Who do I contact with a change of address?
Report your new address to your employer. Your employer will forward your address change to us. And, when visiting your dentist, make sure they have your correct address to use when submitting claims.
Under Michelle's Law, if an unmarried dependent child who was attending a postsecondary educational institution on a full-time basis and is currently covered under the parent's dental benefit policy becomes seriously ill or is injured, he/she may continue to be covered. In order to remain covered, a physician must provide written documentation supporting the need for a medical leave.
Under the law, effective October 1, 2009, students may remain covered under their parent’s dental plan until the earlier of 12 months or until their coverage would otherwise terminate under the policy.
If an unmarried dependent child becomes disabled for an indefinite period of time, (s)he may be considered incapacitated. If the subscriber's dental plan has an incapacitated dependent provision, the subscriber can apply to continue coverage. To be eligible, the dependent:
- Must be incapable of self-support because of mental retardation or any mental or physical disability
- Became disabled before reaching the age limit for coverage
- Depends on the subscriber for financial support and maintenance
In both cases, the subscriber needs to provide document of the illness, injury or incapacitation. The subscriber should print and complete the Disabled Dependent/Michelle's Law Application. Once the form has been completed by the subscriber and the child’s physician, send it to the employer’s benefit representative who will provide the necessary information to Delta Dental.
© Delta Dental Of North Carolina. All Rights Reserved.