We want to help you get the most of your dental plan.  This information is intended to answer general questions you may have about your dental benefits and is not specific to your employers group coverage.  For specific details about your dental plan, please refer to your Dental Benefits Booklet or go to the Benefits & Eligibility page of our website found in the secure Subscriber Log-in section.

For more information, please click on the links below:

Knowing Your Dental Plan
Covered Services and Reimbursement Levels
Benefit Period, Maximums, and Deductibles
Eligible Dependents
Understanding the Dentist Networks
Visiting the Dentist
Predetermination of Benefits
Explanation of Benefits
Meeting Our Customer's Needs
Commonly Used Dental Terms

Depending on the benefit plan options your employer selected, you are most likely enrolled in either the Delta Dental Premier or Delta Dental PPO plan. Delta Dental offers multiple Premier and PPO options with different features. You may know friends that are covered by Delta Dental, but they may be enrolled in a different plan offered by our company. Please see your Dental Benefits Booklet for details about what is covered under your plan. You may also log onto the interactive portion of our Subscriber site by going to the Benefits & Eligibility page, found in our secure Subscriber Log-In section. If you have any further questions about your dental plan coverage, you may also call our friendly Customer Service Representatives at (208) 489-3580.

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Covered Services and Reimbursement Levels

Your dental plan most likely covers three different types of services. Each coverage category provides specific types of treatment at different reimbursement percentages. Below is a list of the typical services covered:

• Preventive & Diagnostic Services (Class I) — such as exams, cleanings, x-rays, and fluoride treatments. These services are typically covered at the highest percentage (for example, 70 percent to 100 percent of the plan's approved fee) in order to encourage preventive care which is imperative to preventing most dental diseases.
• Basic Services (Class II) — such as fillings, extractions, sealants and root canal treatment.
• Major Services (Class III) — such as crowns, dentures, fixed bridges, and implants. These services are usually reimbursed at 50 percent and may have a waiting period before services are covered.

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Benefit Period, Maximums, and Deductibles

Most dental benefits are calculated within a “benefit period,” typically for one calendar year. However, a benefit period may also be determined by the date your employer joined Delta Dental.

Most dental plans also have an “annual dollar maximum”. This is the maximum dollar amount your dental plan will pay toward the cost of dental care within a specific benefit period. You are responsible for costs above the annual maximum as set forth in the contract set forth between your employer and Delta Dental.

In addition, most dental plans specify a specific deductible amount. During the benefit period, you are responsible for that portion of your dental bill before Delta Dental begins payment toward your dental services. Different dental plans vary on this point. For instance, some dental plans will apply the deductible toward preventive treatment and others do not.

To determine your specific benefit period, annual maximum, and deductible amount, see your Dental Benefits Booklet or go to the Benefits & Eligibility page of our website, found in our secure Subscriber Log-In section.

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Eligible Dependents

An employee's spouse and unmarried, dependent children (please see your Benefit Booklet 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 employer’s Benefit Administrator.

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Understanding the Dentist Networks

Delta Dental has two participating dental networks -- Delta Dental Premier and Delta Dental PPO. Some dentists participate in one or both networks. Our Premier network is the largest participating dentist network in the state. Approximately 90% of all dentists in Idaho are members of our Premier network, including specialists in every field. And, approximately 60% of the Premier network dentists participate in our PPO network. And, if you ever need a dentist while you are traveling out of the state, Delta Dental contracts with 124,000 premier dentists across the country.

Your benefits often are based on the type of dentist you see. When you use services from a Delta Dental participating dentist, you receive lower out-of-pocket cost. You are also protected from "balanced billing” which means Delta Dental participating dentists agree to accept Delta Dental fees and your co-payment (if applicable) and deductible as full payment. You may choose to see a non-participating dentist; however, you may need to pay additional out-of-pocket expenses beyond the dentist’s fees.

Delta Dental’s PPO plans offer you a unique “PPO Plus Premier” advantage, which allows you the choice to receive care from either a PPO, Premier, or Non-Participating dentist.  Delta Dental PPO and Premier dentists cannot charge the difference between their fee and Delta Dental’s negotiated fee, protecting you from balance billing.  You receive the greatest level of savings with a PPO dentist because PPO dentists accept a lower fee than Premier dentists.  You also realize costs savings when you use a Premier dentists versus a Non-Participating dentist.

For a list of participating Delta Dental Premier of Delta Dental PPO dentists in your area, select Find A Dentist on the main page of our website.

Visiting the Dentist

With Delta Dental, visiting a dentist is easy. You just need to call and make an appointment. Click here to search for a dentist. When you visit a participating dentist, the rest is taken care of for you. You don’t need to submit claims or forms. The dentist office will do that for you. And, we make it easy for dental offices to quickly and easily access your eligibility and benefit information online or through our ProFax service.

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Predetermination of Benefits

If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, sometimes called a "predetermination of benefits." This will allow you to know in advance exactly what procedures are covered, the amount paid toward treatment, and your financial responsibility.

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Explanation of Benefits (EOB)

Delta Dental will notify you of the amount of benefits paid on your behalf and the amount, if any, due to your dentist. This is called an Explanation of Benefits (EOB). If a service is not covered, the Explanation of Benefits will tell you the reason. Refer to your Dental Benefits Booklet or go to the Benefits & Eligibility page of our website, found in our secure Subscriber Log-In section, for detailed information on covered services, exclusions, and limitations.

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Meeting Our Customer's Needs

We strive to provide superior Customer Service to all of our members. It is important to us to answer your inquiries quickly, professionally, and accurately. For questions or concerns about your dental benefits, please contact our Customer Service representative at (208) 489-3580 or at CustomerService@deltadentalid.com.

Commonly Used Dental Terms

Click here for a list of commonly used dental terms.