Q+A: Continuous Orthodontic Coverage with your DeltaCare USA Plan. Getting affordable dental coverage is easier than ever with a DeltaCare USA¹ plan. Most plans cover extractions for orthodontic purposes at the listed copayment. DeltaCare USA is a dental program that provides you and your family with quality dental benefits at an affordable cost. DeltaCare USA plan features •No deductibles, no Clearly defined copayments • No annual deductibles and no maximums • Low or no costs for many services such . How to use the DeltaCare USA Plan – Choice of Contract Dentist To enroll in this Program, you … Created with Sketch. $25 ($75 for out-of-network care) per person … Estimates may vary depending on your benefit plan and the state you live in. Effective Date January 1, 2019 Benefit Period January 1, 2019 – December 31, 2019 Benefit Period Maximum No Maximum Benefit Period Deductible No Deductible Orthodontia . Mail to: DeltaCare USA Claims Department P.O. The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. Coverage of implants means you have another tool in your toolbox when it comes to recommending the best treatments for your patients. Registration is easy – the three-step process takes just a few minutes. Manage your enrollment and view eligibility and benefits. How do enrollees find a contracted DeltaCare USA orthodontist? Offered through Delta Dental Insurance Company, the DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. DeltaCare® USA Dental benefits the easy way Underwriter Delta Dental of California 17871 Park Plaza Drive, Suite 200 Cerritos, CA 90703 Claims and Correspondence P.O. Q+A: Continuous Orthodontic Coverage with your DeltaCare USA Plan. Every DeltaCare USA enrollee is mailed a Combined Evidence of Coverage and Disclosure Form (EOC) booklet within 30 days of enrollment as part of a welcome packet that also includes ID cards. Plus, earn a $100 statement credit after you make a Delta purchase with your new Card within your first 3 months. DeltaCare® USA Dental benefits made easy! See the copayments for the covered services on the following pages. Contact. DeltaCare® USA (DHMO) Under the DeltaCare® USA program, many services are covered at no cost, while others have copayments (amount you pay your contract dentist) for certain benefits. 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. 2019 Summary of Benefits . At the time of service, enrollees pay the dentist only the listed copayment (found in their plan booklet) for covered services. • Explanation of Benefits showing how much the previous plan has paid to date and amount remaining. Adult & Children • $ 1,150 - $1,900 copay for children to age 19. When you enroll, you select a contract dentist to provide services. * Your benefits may differ from the general information provided here. Treatment-in-progress coverage depends on your plan and applies only if enrollees are in active treatment (banding has taken place). Does the plan cover extractions for orthodontic purposes? You must be a resident of California to enroll. Understanding orthodontic benefits for DeltaCare® USA plans Orthodontics is a dental specialty dedicated to diagnosing, preventing and treating malocclusion (improper alignment of biting or chewing surfaces of upper and lower teeth) through braces, corrective procedures and other appliances to straighten teeth and correct jaw alignment. Refer to your benefit plan to determine whether these requirements apply to you. DeltaCare USA is a dental program that provides you and your family with quality dental benefits at an affordable cost. Dental benefits can help pay for you and your dependents dental expenses. DeltaCare USA (administered by Delta Dental Insurance Company) provides you and your family with quality dental benefits at an affordable cost. If any services are provided by a non-DeltaCare USA Contract Dentist or specialist, you will be obligated to pay for such services. Forgot Instead, you receive up to 25% off the full cost for those services. Main page content Document File(s) DeltaCare Benefits Guide. Copays do not apply to services received from participating specialty dentists. The plan emphasizes preventive care, so many services are provided at no cost. Offered through Delta Dental Insurance Company, the DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to … How do enrollees select or change their general dentist? Footer menu. When you enroll in a DeltaCare USA1 plan, you’ll choose a primary care dentist from our network of carefully screened, private practice dentists. Enrollees should download the Yes. Choice Benefit selections for 2020 Status need to be made by January 31, 2021; selections for 2021 Status need to be made by January 31, 2022. Dental. Date Published December 6, 2018. For other Delta Dental Plans Association member companies, visit the Delta Dental Plans Association website. 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. Here is an example of the effective dates based on plans: When does coverage become effective? Forgot Search for: See recent posts. 1366 0 obj <>stream DeltaCare USA, Premier Access, SafeGuard, and Western Dental. helpful guide with enrollees if they have further questions. Welcome to DeltaCare DeltaCare is an innovative dental plan that provides you with comprehensive care at a significantly lower cost than most other dental plans—which means great value for you. B. DELTACARE®USA COMPREHENSIVE MANAGED CARE PLAN This plan offers a broader range of benefits including some restorative dental procedures (fillings) at no charge after a $5 office visit copayment. DELTACARE USA Managed care option—all dental care must be coordinated through your network dentist DELTA DENTAL PPO To receive the highest level of benefits, use Delta Dental PPO dentists NATIONWIDE NONE KNOW YOUR OPTIONS BEFORE YOU CHOOSE GLOSSARY — Here’s a key to the abbreviations you’ll see throughout this summary chart. Kaiser Permanente Senior Advantage Los Angeles and Welcome to your DeltaCare USA plan! What is DeltaCare USA? benefits DeltaCare USA implants. Dental Medicare Member Portal . All x-rays must be performed by the orthodontist. DeltaCare® USA DENTAL COMPARISON CHART Effective September 1, 2019 State of Texas Dental Choice This is a preferred provider organization (PPO) dental insurance plan. A prepaid plan requires you and your eligible dependents to use a dentist from a specific list of dentists who are located in California and who contract with your selected prepaid carrier. When you enroll, you select a contract dentist to provide services. Effective Date Revised Combined Evidence of Coverage and Disclosure Form Provided by: Delta Dental of California 560 Mission Street, Suite 1300 San Francisco, CA 94105 800-471-9925 deltadentalins.com Administered by: Delta Dental Insurance Company P.O. 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.*. You must visit your selected DeltaCare USA general dentist to receive benefits . (In most states, if they do not select a primary care dentist, Delta Dental will assign one near the enrollee’s home address.). Welcome to your DeltaCare USA plan! DeltaCare® USA (DHMO) Click to play Dental Video: Healthy Tip: Preschedule your next dental appointment at the end of your dental visit to maintain routine treatment for yourself and your family members. Document Description . † $250 Annual Fee. Dentists receive a … Box 1803 Alpharetta, GA 30023 Customer Service 888-282-9501 deltadentalins.com Delta Dental Individual & Family™ DeltaCare® USA CAA54 PB_DCU_I_CAA54_20. You can see any dentist you want, but will pay less if you go to a dentist in one of the two Delta Dental networks: • Delta Dental PPO • Dental Premier Dentists of both the Delta Premier and Delta Dental PPO are in … 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. register for Online Services. Yes, with a referral from the child’s assigned general dentist. DeltaCare® USA DENTAL COMPARISON CHART Effective September 1, 2019 State of Texas Dental Choice This is a preferred provider organization (PPO) dental insurance plan. Estimates may vary depending on your benefit plan and the state you live in. The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. • Explanation of Benefits showing how much the previous plan has paid to date and amount remaining. If the orthodontist recommends x-rays, can they be done by the general dentist? as routine cleanings and exams. Individual PPO plans have flexible enrollment. Preventive care coverage varies by plan and by demographic considerations such as age. Plan CAD48 DeltaCare USA Description of Benefits and Copayments SCHEDULE A Description of Benefits and Copayments The Benefits shown below are performed as deemed appropriate by the attending Contract Dentist subject to the limitations and exclusions of the Program. DeltaCare USA (administered by Delta Dental Insurance Company) provides you and your family with quality dental benefits at an affordable cost. To receive orthodontic benefits, enrollees begin by selecting a DeltaCare USA network orthodontist. DeltaCare works much like a dental HMO, in which you and your family receive all your care from a network of partici DeltaCare ® USA (Dental HMO; California residents only) This plan provides comprehensive benefits and easy referrals to specialists. enrollees web page and give it directly to their orthodontist. DeltaCare USA is a dental program that provides you and your family with quality dental benefits at an affordable cost. DeltaCare USA, Premier Access, SafeGuard, and Western Dental The prepaid plans require you and your eligible dependents to use a dentist from a specific list of dentists who are located in California and who contract with your selected prepaid carrier. %PDF-1.6 %���� The DeltaCare USA plan provides you with quality dental benefits at an affordable rate and is designed to encourage you to visit the dentist regularly to maintain your dental health. Website. Box 1803 Alpharetta, GA 30023 844-697-0578 Follow our simple, three-step registration process and log in to our secure system to see your eligibility information and benefits details. Created with Sketch. DeltaCare USA Plans - DHMO Dental Plans. Benefit Highlights; DeltaCare USA Enrollees: DeltaCare USA is our closed-network plan. Under the DeltaCare® USA program, many services are covered at no cost, while others have copayments (amount you pay your contract dentist) for certain benefits. Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. You must be a resident of California to enroll. endstream endobj startxref You may request electronically a list of your benefits by submitting the online Customer Service Request for DeltaCare USA. Please refer to Schedule B for further clarification of Benefits. Before you enroll, make sure there is a DHMO network dentist in your area. • $1,350 - $2,100 copay for adults. Most basic services are covered at no cost. 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). DeltaCare® USA (DHMO) Under the DeltaCare® USA program, many services are covered at no cost, while others have copayments (amount you pay your contract dentist) for certain benefits. Tuesday, October 1, 2019. Document Type. SCHEDULE C INFORMATION CONCERNING BENEFITS UNDER THE DELTACARE USA PLAN [Group Name] Dental Plan Combined Evidence of Coverage and Disclosure Plan PGE-CA-dc-19 1 INTRODUCTION We are pleased to welcome you to the DeltaCare USA dental plan . flyer1.3 MB for more help on finding a network dentist. It's easy to look up your benefits online, including your dentist network, maximums and deductibles, copayment percentage for standard and orthodontic coverage, and other details. When you enroll, you select a contract dentist to provide services. In Florida, Delta Dental Insurance Company provides DeltaCare USA Plan benefits as a Prepaid Limited Health Service Organization as described in Chapter 636 of the Florida Statutes. These networks are generally quite small. UUP Benefit Trust Fund DeltaCare USA (DHMO) Enrollment Card United University Professions, PO Box 15143, Albany, NY 12212-5143 www.uupinfo.org 800-887-3963 (Phone) or 800-559-0516 (Fax) Please be sure to choose a DeltaCare USA Primary ntist or one will be assigned to you. When you enroll, you select a contract dentist to provide services. A prepaid plan requires you and your eligible dependents to use a dentist from a specific list of dentists who are located in California and who contract with your selected prepaid carrier. Box 1803 Alpharetta, GA 30023 Customer Service 888-282-9501 deltadentalins.com Delta Dental Individual & Family™ DeltaCare® USA CAA54 PB_DCU_I_CAA54_20. Enjoy minimal or no copayments for preventive care and choose from a network of dentists to manage your dental needs. 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. 1317 0 obj <> endobj Orthodontic treatment in progress may be covered for new DeltaCare USA enrollees. These plans will include coverage for all major codes related to the placement and removal of dental implants and abutments. Your employer has chosen to participate in the Exchange and you have selected Delta Dental of California Delta Dental ) to meet … Enrollees must be eligible under their DeltaCare USA plan when the accident occurs. The plan emphasizes preventive care, so many services are provided at no cost. Invisalign and other specialty appliances will result in additional fees. The orthodontist will complete the form and mail it to our DeltaCare USA Claims department, along with the required supporting documents. >> Benefit Eligibility Note: • All M-DCPS groups are eligible to enroll in the DeltaCare USA (DHMO) offered by the School Board. The primary care dentist coordinates specialty care needs for oral surgery, pediatric dentistry, endodontics or periodontics with a DeltaCare USA network specialist. No. See the "Limitations and Exclusions of Benefits." Phone (800) 893-3582. e-magazine Your group contract serves as the controlling document of your plan. Box 1810 Alpharetta, GA 30023. Primary care dentists may be able to help find an orthodontist within the DeltaCare USA network. Upon enrollment, enrollees will receive a plan booklet with defined copayments for covered services. This benefit is not offered to employees represented by Fraternal Order of Police (FOP) Enrollment Information; Your Benefits; Part-time New Hire FAQ’s ; Rates; DeltaCare USA Plans - DHMO Dental Plans. Box 1810 Alpharetta, GA 30023. Welcome to DeltaCare USA — quality, convenience, predictable costs DeltaCare USA (administered by Delta Dental Insurance Company) provides you and your family with quality dental benefits at an affordable cost. by your selected DeltaCare USA Contract Dentist. Most DeltaCare USA plans allow enrollees to continue treatment started under a previous dental plan. DeltaCare USA for Small Businesses Group Name Group No. Share this Wellness DeltaCare USA (administered by Delta Dental Insurance Company) provides you and your family with quality dental benefits at an affordable cost. It offers a wide range of benefits for specialty referrals when you are referred by your participating general dentist. Review your group contract for specific details regarding coverage under your plan. DeltaCare® USA Dental benefits made easy! DeltaCare USA, Premier Access, SafeGuard, and Western Dental. Enrollees should obtain an estimate from their orthodontist prior to beginning treatment. Plan CAD48 DeltaCare USA Description of Benefits and Copayments SCHEDULE A Description of Benefits and Copayments The Benefits shown below are performed as deemed appropriate by the attending Contract Dentist subject to the limitations and exclusions of the Program. All treatment plans are different. DeltaCare USA DHMO, focuses on maintaining oral health, prevention and cost containment. The orthodontist can access the form directly from the Provider Tools Reference Library on our website. Earn 40,000 bonus miles and 5,000 Medallion Qualification Miles (MQMs) after you spend $2,000 in eligible purchases on your new Delta SkyMiles® Platinum American Express Card within your first 3 months. The DeltaCare USA network consists of private practice DeltaCare ® USA plan. The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. The plan covers a wide array of services, and preventive care — like routine cleanings and exams — is covered at little or no cost.². DeltaCare USA program. Can enrollees find out how much orthodontic treatment will cost? Enrollees must enter their location and select the DeltaCare USA network from the drop-down menu. Dentists receive a flat fee for each member assigned to their offices. Much like medical HMOs, dental maintenance organizations require that you receive all of your dental care from a limited network of contracted dental offices. However, benefits are not provided for any dental treatment started before joining the program (that is, work in progress, such as preparations for crowns, root canals and impressions for dentures). However, benefits are not provided for any dental treatment started before joining the program (that is, work in progress, such as preparations for crowns, root canals and impressions for dentures). Delta Dental Patient Direct Delta Dental Patient Direct is a dental service discount plan. (States are rated and approved for each group. General information regarding cost estimates. 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. This option provides excellent coverage with predictable copayments. DeltaCare® USA Dental Health Care Program for Eligible Employees and Dependents Combined Evidence of Coverage and Disclosure Form STATE OF MARYLAND MDD57 Provided by: Delta Dental of Pennsylvania One Delta Drive Mechanicsburg, PA 17055 Administered by: Delta Dental Insurance Company P.O. Dependent children include natural children, step-children, adopted children, children placed for adoption and children of a Spouse. Password? Visit your DeltaCare USA dentist. † Related. 2019 Summary of Benefits . Is general anesthesia/intravenous sedation covered? Under the DeltaCare® USA program, many services are covered at no cost, while others have copayments (amount you pay your contract dentist) for certain benefits. Dental services that are not performed by your selected in-network participating (contracted) dentist, or are not covered under provisions for emergency care below, must be … Refer to your group contract to determine if this coverage is included with your plan. DELTACARE USA (Managed care option) 50% coverage up to $2,000 per child to age 26 (lifetime) for in-network care ($1,500 for out-of-network care) EMERGENCY TREATMENT, PALLIATIVE (TO RELIEVE PAIN) PREDETERMINATION OF BENEFITS BASIC COVERAGE MAJOR COVERAGE ORTHODONTIA DENTAL ACCIDENT PREVENTIVE COVERAGE You pay a fixed copay for a standard 24-month course … Individual PPO plans have flexible enrollment. No. Box 1803 Alpharetta, GA 30023 800-471-9925 deltadentalins.com CoveredCA.com 800 … © Delta Dental This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. See the copayments for the covered services on the following pages. DeltaCare USA is a managed dental care plan. Refer to your group contract to determine if this coverage is included with your plan. Here is an example of the effective dates based on plans: When does coverage become effective? Delta Dental plans and features. Created with Sketch. Once enrollees start treatment they cannot switch orthodontists. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis. Under the DeltaCare® USA program, many services are covered at no cost, while others have copayments (amount you pay your contract dentist) for certain benefits. Are pre-existing dental conditions and treatment-in-progress covered? When you enroll in a DeltaCare USA1 plan, you’ll choose a primary care dentist from our network of carefully screened, private practice dentists. Adult Enrollees eligible for Adult Benefits are:  a Primary Enrollee 19 years of age or older; and/or  a age 19 to age 26. 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.*. For a complete description of the details of your coverage, please refer to your coverage documents. Enrollees should obtain a detailed treatment plan with all procedures and costs when visiting their orthodontist for the first time. 2019 Summary of Benefits (SOB) DeltaCare USA DHMO. Orthodontic treatment in progress may be covered for new DeltaCare USA enrollees. Enrollees can read this The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. DeltaCare ® USA (Dental HMO; California residents only) This plan provides comprehensive benefits and easy referrals to specialists. Orthodontic treatment-in-progress may be covered for new DeltaCare USA enrollees. Username or Enrollees are responsible for the listed copayment. 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