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Subscribers Frequently Asked Questions
 
Delta Dental of Idaho > Subscribers > Frequently Asked Questions Sunday, December 21, 2014

What dentist can I see?

Can I see a specialist with my plan?

How can I find out what my remaining benefits are for this current benefit year?

What are the benefits and covered services under my dental plan?

Can I or my dependents enroll in dental coverage at any time?

How long are my children covered under my dental plan?

How does the American Recovery and Reinvestment Act of 2009 affect my COBRA coverage?

What does the term "least costly" mean?

What is a Delta Dental "member dentist"?

How can I obtain a list of Delta Dental member dentists?

Who do I call if I have questions about my dental plan benefits?

How can I get a Delta Dental dental benefits booklet?

I misplaced my benefit ID card. Can I get another one?

Does Delta Dental offer individual plans?

Does Delta Dental require claim forms? Where should claims be sent?

How will I know when my claim is processed? Who can I call if I have a question about it?

What is an annual maximum and deductible?

How long will it take to process my claim?

I received an Explanation of Benefits notification? What is this?

I'm covered under two dental plans. How will you handle my coverage?

Who decides what the yearly maximum for services will be?



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What dentist can I see?

We offer the largest dental network in the state. Approximately 9 out of every 10 dentist in Idaho is a Delta Dental Premier participating dentist, including specialists in every field. And, nearly 50% of all the Premier dentists are participate in our PPO network. You may choose to see any licensed dentist, including a non-participating dentist. However, if you receive services from a non-participating dentist you may have additional out-of-pocket expenses beyond the dentist’s fees.

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Can I see a specialist with my plan?

Specialist services are a covered benefit under most plans, and the same Premier and PPO agreements apply. For a list of participating Premier specialists, click Find a Dentist. You may want to have the specialist submit a preauthorization to determine how much of a benefit you can expect to receive.

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How can I find out what my remaining benefits are for this current benefit year?

Click on Claims Information after logging into the secure Subscriber Log-In section to view your claims history information. You may also contact our Customer Service at (208) 489-3580 and we will review your claims history to determine how much you have remaining, or you can use Delta Dental's ProFax. Click here for the ProFax Call Guide in PDF format.

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What are the benefits and covered services under my dental plan?

Click on Your Benefit Booklet & ID Cards after logging into the secure Subscriber Log-In section to view and print your dental benefit information. You may also contact your employer.

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Can I or my dependents enroll in dental coverage at any time?

You or your eligible dependents may be enrolled based on your employer contract. Coverage can also be added at any time as the result of a qualifying event, such as marriage, births, and legal adoptions. If you or your dependents enroll following completion of the eligibility period or not as a result of a qualifying event, you and/or your dependents will be considered a late enrollee and will have an additional waiting period for major services.

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How long are my children covered under my dental plan?

Refer to your Benefit Booklet for the specific age limits under your plan.

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What does the term "least costly" mean?

If a tooth can be restored with a procedure that is less expensive than the procedure rendered, benefits paid will be based on the procedure that costs less.

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What is a Delta Dental "member dentist"?

A Delta Dental member dentist is a dentist who has signed an agreement with Delta Dental stipulating that he or she will provide dental treatment to subscribers covered by Delta Dental's group dental care programs. Delta Dental member dentists submit claims directly to Delta Dental for their patients.

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How can I obtain a list of Delta Dental member dentists?

You can access a list of Delta Dental Premier and PPO participating dentists by going to Find A Dentist.

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Who do I call if I have questions about my dental plan benefits?

If you have questions about your dental benefits, call Delta Dental's Customer Service department (208) 489-3580 or e-mail them at CustomerService@deltadentalid.com.

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How can I get a Delta Dental dental benefits booklet?

Click on Your Benefit Booklet & ID Cards after logging into the secure Subscriber Log-In section to view and print your dental benefit information. You may also contact your employer.

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I misplaced my benefit ID card. Can I get another one?

Click on Your Benefit Booklet & ID Cards after logging into the secure Subscriber Log-In section to print your benefit ID card. You may also call our Customer Service department at (208) 489-3580.

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Does Delta Dental offer individual plans?

Yes! Visit https://secure.deltadentalid.com/IndividualPlan/index.aspx for more information and to enroll.

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Does Delta Dental require claim forms? Where should claims be sent?

Most dental offices (and all Participating Dentists' offices) have standardized forms. Otherwise, no special claim forms are needed. All claim processing is done right here in Idaho. Claims are to be sent directly to:

Delta Dental of Idaho
P.O. Box 2870
Boise, Idaho 83701

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How will I know when my claim is processed? Who can I call if I have a question about it?

You will receive an Explanation of Benefits that describes the services your dentist submitted and the benefits that your plan provided. You may also access your claims information on our website by clicking on Claims Information after logging into the secure Subscriber Log-In section. Call Customer Service at (208) 489-3580, if you have a question about a claim, or you can use Delta Dental's ProFax. Click here for the ProFax Call Guide in PDF format.

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What is an annual maximum deductible?

An annual maximum is the maximum amount your dental plan will pay in benefits during the calendar year or plan year. Most companies select calendar year, which is January 1st through December 31st, however some select a plan year that corresponds to when their group's benefits renew (or open enrollment). A deductible is the dollar amount of covered dental expenses you must pay during the year before plan benefits are paid and normally applies to Basic and Major Services. The deductible can be set on either a calendar or plan year. Please refer to your member benefit materials or contact our Customer Service department at (208) 489-3580 to confirm your calendar or plan year dates.

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How long will it take to process my claim?

Over 90% of claims processed through our automated claims system are paid in less than 15 business days if they are complete and eligibility can be verified. You will receive an Explanation of Benefits (EOB) notification that summarizes the services you received, the amount we paid the participating provider and your co-payment and/or deductible amount (if applicable).

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I received an Explanation of Benefits notification. What is this?

An Explanation of Benefits (EOB) notification summarizes the dental services you received. We mail an EOB to the subscriber and participating provider. The EOB lists the claim number, a description of services, the dentists' charge, Delta Dental Plan's payment and the patient responsibility (co-payment and/or deductible if applicable) You may also opt-in to begin receiving your Explanation of Benefits by email in the Modify Contact Information on the secure portion of our website.

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I'm covered under two dental plans. How will you handle my coverage?

If you and your family are covered by more than one dental plan (or a medical plan that offers dental coverage), Delta Dental will coordinate benefits with the other carrier. In determining coverage, total payments from both carriers cannot exceed the allowable charge for the service. If you have a question about Coordination of Benefits (COB), please contact our Customer Service department at (208) 489-3580.

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Who decides what the yearly maximum for services will be?

In most instances, the employer group, who is purchasing dental benefits for their employees, is the decision-maker regarding the benefits (co-pays, deductibles and maximums) to be offered.

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