The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. Dental benefits can help pay for you and your dependents dental expenses. The information below applies to our standard processing policies and contract coverage, and is to be used only as a guide. Enrollees must enter their location and select the DeltaCare USA network from the drop-down menu. For more information about your dental benefits, visit the Delta Dental Medicare Member Portal below. Adult Enrollees eligible for Adult Benefits are: a Primary Enrollee 19 years of age or older; and/or a age 19 to age 26. For other Delta Dental Plans Association member companies, visit the Delta Dental Plans Association website. Enrollees should obtain a detailed treatment plan with all procedures and costs when visiting their orthodontist for the first time. 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. Individual PPO plans have flexible enrollment. Yes, with a referral from the child’s assigned general dentist. DeltaCare Benefits Guide. Dentists receive a … Much like medical HMOs, dental maintenance organizations require that you receive all of your dental care from a limited network of contracted dental offices. Preventive services are included in this tool. DeltaCare ® USA (Dental HMO; California residents only) This plan provides comprehensive benefits and easy referrals to specialists. Document Description . as routine cleanings and exams. DeltaCare ® USA plan. DeltaCare USA Plan 11A (Spanish).pdf . Dependent children include natural children, step-children, adopted children, children placed for adoption and children of a Spouse. It offers a wide range of benefits for specialty referrals when you are referred by your participating general dentist. Most basic services are covered at no cost. 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. See the copayments for the covered services on the following pages. Box 1810 Alpharetta, GA 30023. Here is an example of the effective dates based on plans: When does coverage become effective? See the "Limitations and Exclusions of Benefits." DeltaCare USA Continuous Orthodontic Coverage form. DeltaCare USA is Delta Dental’s dental HMO, which offers low-cost dental coverage with a focus on preventive care. Share … Dental Medicare Member Portal . Download. 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. Your group contract serves as the controlling document of your plan. Refer to your benefit plan to determine whether these requirements apply to you. Benefit Summary . 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 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). If any services are provided by a non-DeltaCare USA Contract Dentist or specialist, you will be obligated to pay for such services. Main page content Document File(s) DeltaCare Benefits Guide. Refer to your group contract for full details). Benefits information. 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. 2019 Summary of Benefits (SOB) DeltaCare USA DHMO. Tuesday, October 1, 2019. 2019 Summary of Benefits . $25 ($75 for out-of-network care) per person … Dental. Preventive care coverage varies by plan and by demographic considerations such as age. The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. Please refer to Schedule B for further clarification of Benefits. Enrollees can search for a dentist using the Find a Dentist feature on the right side navigation on 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. 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. Individual PPO plans have flexible enrollment. Are pre-existing dental conditions and treatment-in-progress covered? 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. Review your group contract for specific details regarding coverage under your plan. The plan is unique in its emphasis on preventive services, which are fully covered. When you enroll, you select a contract dentist to provide services. Enrollees are responsible for the listed copayment. DeltaCare USA (administered by Delta Dental Insurance Company) provides you and your family with quality dental benefits at an affordable cost. When you enroll, you select a contract dentist to provide services. 1 If you wish to change the DeltaCare USA network dentist assigned to you at enrollment, please contact us online or by phone to make the change. 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). UT … The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. Estimates may vary depending on your benefit plan and the state you live in. You must be a resident of California to enroll. register for Online Services. Enrollees should download the 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 … Their copayments, limitations and exclusions are determined by the group contract.*. Treatment-in-progress coverage depends on your plan and applies only if enrollees are in active treatment (banding has taken place). 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. 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. The plan emphasizes preventive care, so many services are provided at no cost. 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. Enrollees must receive care from their selected/assigned primary care dentist within the DeltaCare USA network. Refer to your group contract to determine if this coverage is included with your plan. Registration is easy – the three-step process takes just a few minutes. All x-rays must be performed by the orthodontist. This option provides excellent coverage with predictable copayments. Box 1803 Alpharetta, GA 30023 Customer Service 888-282-9501 deltadentalins.com Delta Dental Individual & Family™ DeltaCare® USA CAA54 PB_DCU_I_CAA54_20. 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. Adult & Children • $ 1,150 - $1,900 copay for children to age 19. 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. DeltaCare USA Plans - DHMO Dental Plans. Does the plan cover extractions for orthodontic purposes? Once enrollees start treatment they cannot switch orthodontists. These plans will include coverage for all major codes related to the placement and removal of dental implants and abutments. 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. Welcome to your DeltaCare USA plan! Date Published December 6, 2018. DeltaCare USA is a managed dental care plan. Web features for DeltaCare USA enrollees. Username or Getting affordable dental coverage is easier than ever with a DeltaCare USA¹ plan. These plans are designed to address the growing demand by DeltaCare USA members for dental implants. When you enroll, you select a contract dentist to provide services. 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. Accident injury benefits are subject Can enrollees find out how much orthodontic treatment will cost? 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 … Upon enrollment, enrollees will receive a plan booklet with defined copayments for covered services. under your plan. Most DeltaCare USA plans allow enrollees to continue treatment started under a previous dental plan. 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. This document is a combined Evidence of Coverage and Disclosure Form for your Dental HMO Program. Website. You may request electronically a list of your benefits by submitting the online Customer Service Request for DeltaCare USA. Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. If you or an eligible member of your family has How do enrollees begin orthodontic treatment? 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. Please refer to Schedule B for further clarification of Benefits. Each … Enrollees can read this Created with Sketch. Delta Dental Patient Direct Delta Dental Patient Direct is a dental service discount plan. Contact. Welcome to your DeltaCare USA plan! Invisalign and other specialty appliances will result in additional fees. H0524_19SB003_M PBP 003 60872209 S 003 January 1–December 31, 2019 . For a complete description of the details of your coverage, please refer to your coverage documents. Dentists receive a flat fee for each member assigned to their offices. 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. If you or an eligible member of your family has The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. 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. 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. Related. Plan Benefit Summaries. 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 works much like a dental HMO, in which you and your family receive all your care from a network of partici DeltaCare USA program. Password? Q+A: Continuous Orthodontic Coverage with your DeltaCare USA Plan. DeltaCare® USA Dental benefits made easy! DeltaCare® USA DHMO Plan . H0524_19SB003_M PBP 003 60872209 S 003 January 1–December 31, 2019 . THE COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM AND THE PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. 2019 Summary of Benefits . 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. 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. DeltaCare USA, Premier Access, SafeGuard, and Western Dental. Orthodontic treatment-in-progress may be covered for new DeltaCare USA enrollees. Offered through Delta Dental Insurance Company, the DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to … Yes, your DeltaCare USA plan provides coverage for accidental injury (caused by external forces) at 100% of the contract dentist’s “filed fees” for benefits (less any applicable copayments). The DeltaCare USA network consists of private practice DeltaCare USA is Delta Dental’s dental HMO, which offers low-cost dental coverage with a focus on preventive care. * Your benefits may differ from the general information provided here. 1317 0 obj <> endobj Search for: See recent posts. Delta Dental plans and features. Plan Benefits. 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. † 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 … flyer1.3 MB for more help on finding a network dentist. See the copayments for the covered services on the following pages. Most plans cover extractions for orthodontic purposes at the listed copayment. Enrollees should discuss all treatment options with … DeltaCare USA is a dental program that provides you and your family with quality dental benefits at an affordable cost. Yes. Instead, you receive up to 25% off the full cost for those services. 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. Box 1803 Alpharetta, GA 30023 844-697-0578 You must visit your selected DeltaCare USA general dentist to receive benefits . Phone (800) 893-3582. The orthodontist will complete the form and mail it to our DeltaCare USA Claims department, along with the required supporting documents. Refer to your group contract to determine if this coverage is included with your plan. Responsible Office(s) Employee Benefits. You must use network providers and choose a primary care dentist (PCD). 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. No. 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. Delta Dental/DeltaCare USA/Plan 10A – Plan 15B, Plan 48N. DeltaCare® USA Dental benefits made easy! With our Online Services, it’s simple for your DeltaCare USA enrollees to maximize their plan. There are no yearly maximums or deductibles. Box 1803 Alpharetta, GA 30023 Customer Service 888-282-9501 deltadentalins.com Delta Dental Individual & Family™ DeltaCare® USA CAA54 PB_DCU_I_CAA54_20. Release Date. DeltaCare® USA DENTAL COMPARISON CHART Effective September 1, 2019 State of Texas Dental Choice This is a preferred provider organization (PPO) dental insurance plan. Password? 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. Created with Sketch. If the orthodontist recommends x-rays, can they be done by the general dentist? Visit your DeltaCare USA dentist. 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. Orthodontic treatment in progress may be covered for new DeltaCare USA enrollees. How do enrollees select or change their general dentist? General information regarding your dental benefits. Enrollees should discuss all treatment options with … Is general anesthesia/intravenous sedation covered? e-magazine Upon enrollment, enrollees will receive a plan booklet with defined copayments for covered services. 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 coverage is available to adults and children. Q+A: Continuous Orthodontic Coverage with your DeltaCare USA Plan. No. Dentist changes made by the 21st of the month will take effect on the first of the following month. Box 1803 Alpharetta, GA 30023 800-471-9925 deltadentalins.com CoveredCA.com 800 … 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. How to use the DeltaCare USA Plan – Choice of Contract Dentist To enroll in this Program, you … • Explanation of Benefits showing how much the previous plan has paid to date and amount remaining. 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