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FREQUENTLY ASKED QUESTIONS

Delta Dental Individual 
and FamilySM Plans

   

FREQUENTLY ASKED
QUESTIONS

Delta Dental Exchange Certified Plans

 

Enrollment Questions

Dependent Questions

Dentist Office Questions

Insurance Questions

Claims Questions

 

ANSWERS TO ENROLLMENT QUESTIONS

Q: Who is eligible to purchase a Delta Dental Individual and Family dental plan?
A: You are eligible to enroll in a Delta Dental Individual and Family plan if you are a Kansas resident and at least 18 years of age. Dependents are covered to age 26, if they are unmarried. Acceptance is guaranteed regardless of dental history or pre-existing conditions.

Q: What is the difference between the Platinum, Gold, Silver and Bronze plans?
A:
The biggest difference is in the services that are covered. The Bronze plan has a focus on preventive services, including coverage for check-ups and cleanings, and basic dental services such as fillings and non-surgical extractions. The Platinum, Gold and Silver plans are more comprehensive plans with coverage for major services such as crowns, dentures and surgical extractions. The Platinum plan is the only plan with implant coverage. Please refer to our
 Delta Dental Individual and Family Plans page for complete information about each option.

Q: What is the difference between Delta Dental PPO, Delta Dental Premier and out-of-network dentists?
A:
The Delta Dental Premier network is the largest managed fee-for-service network with more than 90% of Kansas dentists participating. The Delta Dental PPO network is the largest PPO network with more than 60% of Kansas dentists participating. Generally, patients who receive services from a Delta Dental PPO dentist experience greater out-of-pocket savings.

With your Delta Dental Individual and Family plan, you may see any dentist you wish. Even if your dentist does not participate in a Delta Dental network, you can receive treatment and still receive Delta Dental benefits. However, there are many advantages to seeing a dentist who is a member of the Delta Dental PPO or Delta Dental Premier networks. By going to a Delta Dental PPO or Delta Dental Premier dentist, you will have lower out-of-pocket expenses than going to an out-of-network dentist.

Q: How can I find out if my dentist is part of the Delta Dental network?
A:
The easiest and most up-to-date listings can be found through our online
 Locate a Dentist tool. You can search for dentists by their name, practice name, or specialty. Results can be sorted by name, practice name or driving distance, and your list can be printed, emailed and viewed as a PDF.

Q: How do I enroll in Delta Dental Individual and Family?
A:
You may enroll in Delta Dental Individual and Family by completing an
online application, or print and mail a paper application to Delta Dental of Kansas, P.O. Box 3806, Wichita, KS 67201-3806.

Q: What are my payment options?
A:
Delta Dental of Kansas has two payment options. If you
enroll online you may choose to pay with a credit/debit card or through automatic withdrawal from a checking or savings account (EFT). Monthly premiums will be charged within the first five business days of the month. If you prefer to pay using a check, you may purchase a year's worth of premiums and send your check to DDKS with the paper application.

Q: When does my coverage start?
A:
Once your online application and initial payment are processed, you will receive an email confirmation in 5 to 7 days as well as a copy of your policy and directions for printing your ID card(s). If your application is received on or before the 25th of the month, coverage will start on the first of the following month. If your application is received after the 25th of that month, coverage will start on the first of the next month.

Q: Are there waiting periods?
A:
There are no waiting periods for diagnostic and preventive services, such as exams or cleanings. There is a 6-month waiting period for all plans for basic restorative services, such as fillings and non-surgical extractions. If you enroll in the Platinum, Gold or Silver plans, there is a 12-month waiting period for major services, such as crowns, oral surgery and dentures.

Q: How can I cancel my policy?
A:
You can cancel your policy by sending written notice to Delta Dental at least 30 days prior to your requested termination date. Terminations will always be the last day of the month. For instance, if you request a May 31 termination date, your written request must be received at Delta Dental on or before April 30.

Q: How long are the rates guaranteed?
A:
Your rates are guaranteed for one full year. For example, if you enroll in May 2016, your rate is guaranteed until May 2017. You will be notified 60 days prior to your renewal date of any future rate changes.

Q: Are there services that are not covered?
A:
Yes. Services that are not covered include braces and cosmetic procedures (e.g., teeth whitening). Covered services are plan-specific and subject to Exclusions and Limitations. Please see our
Delta Dental Individual and Family Plans page.

Q: With my Delta Dental Individual plan, do I have coverage outside of Kansas?
A:
Yes, your Delta Dental coverage travels with you. Common examples are: a secondary residence outside of Kansas, full-time students attending college in another state, traveling outside of Kansas within the United States.

Q: What if I permanently move out of Kansas?
A:
Your coverage would terminate at the end of the month in which you changed residency. Plans are open to Kansas residents only, which means that you must reside in Kansas at least six months of the year.

Q: Where can I find my complete plan information?
A:
Complete plan information will be mailed to you 5 to 7 business days after enrollment. You may also login to the
Subscriber Connection online to view your benefits and eligibility.

Q: Who should I contact with questions about my coverage?
A:
 After enrolling, if you have questions about your Delta Dental Individual and Family plan, including your coverage and eligibility, you can call Customer Service at (800) 234-3375.

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ANSWERS TO DEPENDENT QUESTIONS

Q: My child has braces and we just switched to Delta Dental. Are our orthodontic payments covered under our Delta Dental Individual and Family insurance?
A:
No, Delta Dental Individual and Family plans do not cover orthodontia (braces).

Q: I have a fully-disabled dependent; how long is he/she covered under my policy?
A:
As long as the individual remains disabled and is fully dependent on you for support and unmarried, he or she can remain a dependent on your insurance policy. Written proof is required from the attending physician to verify the dependent's disability.

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ANSWERS TO DENTIST OFFICE QUESTIONS

Q: I haven't received my ID card yet, but I have an appointment scheduled. What information does my provider need? How can I obtain an ID card?
A:
Your dental office will need to your social security number or member identification number. The dentist's office may also call our office to verify coverage. You can print ID cards from the
Subscriber Connection or download the Delta Dental mobile app to simply login to view your ID card, show it at the dental office or email it to a dependent or dentist.

If you are a new website user, select the 'New users register here' link and follow the directions to register. Once registered, type in your user name and password at the prompts and then select the 'Sign In' button. From the next page, click 'ID Cards'.

Q: May I visit any dentist I wish for treatment? What if my dentist doesn't participate with Delta Dental?
A:
You are free to visit any dentist. However, if the dentist is not a participating dentist, you may have more out-of-pocket expense and will be responsible for the difference between Delta Dental's payment and the dentist's fee, along with your coinsurance. In addition, depending on your plan, your coverage may involve a different co-insurance percentage if you go to a dentist who doesn't participate in Delta Dental's network. Locate a participating dentist using our online
 Locate a Dentist tool or by contacting our Customer Service department at (800) 234-3375.

Q: How do you handle claims submitted by an out-of-network dentist?
A:
Please note that if you visit an out-of-network dentist, you may be required to submit a claim form for the services rendered and possibly pay the entire amount up front. In all instances, when a non-participating dentist renders services, any payment made by Delta Dental will be made directly to you, the subscriber.

 

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ANSWERS TO INSURANCE QUESTIONS

Q: What is Delta Dental of Kansas' mailing address?
A:
P.O. Box 789769, Wichita, KS 67278-9769

Q: I just received something in the mail from Delta Dental that looks like a bill. What is it?
A:
You probably received an Explanation of Benefits (EOB) statement. This statement is not a bill; it explains what services your dentist provided and how Delta Dental processed and paid for the services.

Q: What are predeterminations and are they mandatory?
A:
A predetermination of benefits allows you to know in advance what procedures are covered, the amount your plan will pay toward treatment and your financial responsibility. Treatment plans that involve prosthodontic services, orthodontic services, individual crowns (except stainless steel), gold restorations, surgical periodontics, endodontics and oral surgery, except for simple extraction of a single tooth, should be submitted to Delta Dental for predetermination of benefits. Please refer to your Benefits Booklet to for more information.

Q: Does my coverage run on a calendar year?
A:
Your coverage runs on a contract year. For example, if you enroll in a plan in May 2014, your coverage will renew in May 2015. The anniversary date for coverage varies. For specific information on your benefits or benefit year, login to the
Subscriber Connection. You can also check your Benefits Booklet or contact our Customer Service department at
(800) 234-3375.

Q: What is a deductible?
A:
A deductible is the annual amount you pay before the dental benefits are payable. Visit the 
Delta Dental Individual and Family Plans page to see which services require a deductible.

Q: Do I need a referral to see a specialist?
A:
If you're a member of Delta Dental, you do not need a referral to receive care from a specialist. However, we strongly encourage you to use the services of a Delta Dental participating specialist to maximize your benefit coverage.
Locate a participating specialist.

Q: How do I check to see if I am eligible for coverage?
A:
If you're a Kansas resident, age 18 or older, you're eligible to enroll in a Delta Dental Individual and Family plan. Once enrolled, it's easy to check your current eligibility status and view a summary of your plan's dental benefits online using the
Subscriber Connection. Or, you can contact our Customer Service department at (800) 234-3375.

Q: When can I switch plans?
A:
You may only switch Delta Dental Individual and Family plans at your time of renewal.

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ANSWERS TO CLAIMS QUESTIONS

Q: Are implants covered?
A:
Yes, but only on the Platinum plan. Covered services such as implants are subject to a pre-determination and other limitations as explained by the Subscription Agreement.

Q: I had a tooth surgically pulled (extracted) and the insurance claim was filed with my medical insurance. Why doesn't my dental insurance cover the claim?
A:
Depending on your plan coverage, claims for surgical extraction of wisdom teeth may need to first be submitted to your medical insurance carrier and then to your dental insurance. Some medical plans pay up to 100% of this procedure, so filing this type of extraction with your medical insurance could be of benefit to you. If there are any remaining charges after the medical insurance carrier has paid, your dental plan may cover the remainder or a portion of the remaining balance. Contact our Customer Service department at (800) 234-3375 for specific details regarding your plan.

Q: Why was my exam not covered when my dentist referred me to a specialist?
A:
According to your plan, an examination is a covered benefit once every six months. This is true whether the examination is performed by a general dentist or by a specialist.

Q: I had individual x-rays taken and Delta Dental paid for a full mouth x-ray. Why?
A:
Delta Dental's policy states that the fee for individual bitewing x-rays cannot be higher than the fee for a full-mouth x-ray series. If this occurs, Delta Dental will pay the amount for a full-mouth x-ray series.

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If you have additional questions, please contact us.

  

Enrollment Questions

Dentist Office Questions

Insurance Questions

 

ANSWERS TO ENROLLMENT QUESTIONS

Q: Who is eligible to purchase an exchange-certified pediatric dental plan?
A: Delta Dental Individual and Family + POEHB plans are exchange-certified under the Affordable Care Act. Both the Basic and Preferred plans may be purchased as:

- Adult(s)-only
- Child(ren)-only                          
- Family

Children are defined as age 18 and under; Adults are defined as age 19 and above. Acceptance is guaranteed regardless of dental history or pre-existing conditions.

Q: What is the difference between the Basic and Preferred plans?
A: The biggest difference is in the coverage levels. The Preferred plan offers additional coverage for basic dental services and features a lower deductible. Both plans focus on preventive services, including coverage for check-ups and cleanings, basic dental services such as fillings and extractions, and major services like crowns and dentures. Please refer to our Exchange Certified Plans page for complete information about each option.

Q: What is the difference between in-network and out-of-network dentists?
A: With your Delta Dental Individual and Family + POEHB plan, you are free to go to any dentist of your choosing; however, you will typically have lower out-of-pocket expenses when you visit a Delta Dental PPO dentist. Only services provided by a Delta Dental PPO dentist are considered in-network when calculating the Maximum Out-of-Pocket under this plan. It is to your advantage to choose a Delta Dental PPO dentist.

Q: How can I find out if my dentist is part of the Delta Dental network?
A: The easiest and most up-to-date listings can be found through our online Locate a Dentist tool. You can search for dentists by their name, practice name, or specialty. Results can be sorted by name, practice name or driving distance, and your list can be printed, emailed and viewed as a PDF.

Q: How do I enroll in a Delta Dental Individual and Family+ POEHB plan?
A: You may enroll in a Delta Dental Individual and Family + POEHB plan online. Delta Dental Exchange Certified plans can only be purchased through HealthCare.gov during the open enrollment period unless you qualify for a Special Enrollment Period. Visit Healthcare.gov for more information.

Q: Are there services that are not covered?
A: Yes, there are multiple services that are not covered, including braces (unless they meet the definition of 'medically necessary') and cosmetic procedures (e.g., teeth whitening). Covered services are plan-specific. Please see our Exchange Certified Plans page for more details.

Q: With my Delta Dental Individual and Family + POEHB plan, do I have coverage outside of Kansas?
A: Yes. Locate a Dentist tool to find dental offices throughout the United States.

Q: What if our family permanently moves out of Kansas?
A:
Your coverage would terminate at the end of the month in which you changed residency. Plans are open to Kansas residents only, which means that you must reside in Kansas at least six months of the year.

Q: Who should I contact with questions about my coverage?
A: After enrolling, if you have questions about your Delta Dental Individual and Family + POEHB plan, including your coverage and eligibility, you can call Customer Service at (800) 234-3375.

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ANSWERS TO DENTIST OFFICE QUESTIONS

Q: I haven't received my ID card yet, but I have an appointment scheduled. What information does my provider need? How can I obtain an ID card?
A: Your dental office will need your social security number or member identification number. The dentist's office may also call our office to verify coverage. You can print ID cards from the Member Login at www.deltadentalcoversme.com.

If you are a new website user, select the 'New users register here' link and follow the directions to register. Once registered, type in your user name and password at the prompts and then select the 'Sign In' button. From the next page, click 'ID Cards'.

Q: May I visit any dentist I wish for treatment? What if my dentist doesn't participate with Delta Dental?
A: You are free to visit any dentist. However, if the dentist is not a Delta Dental PPO dentist, you may have more out-of-pocket expense and services will not count toward the Maximum Out-of-Pocket amount. If you visit a non-participating provider, you will be responsible for the difference between Delta Dental's payment and the dentist's fee, along with your coinsurance. It is to your advantage to visit a Delta Dental PPO dentist. Locate a participating dentist using our online Locate a Dentist tool or by contacting our Customer Service department at (800) 234-3375.

Q: How do you handle claims submitted by an out-of-network dentist?
A: Please note that if you visit a non-participating dentist, you may be required to submit a claim form for the services rendered and possibly pay the entire amount up front. In all instances, when a non-participating dentist renders services, any payment made by Delta Dental will be made directly to you, the subscriber. 

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ANSWERS TO INSURANCE QUESTIONS

Q: What is Delta Dental of Kansas' mailing address?
A:
P.O. Box 789769, Wichita, KS 67278-9769

Q: I just received something in the mail from Delta Dental that looks like a bill. What is it?
A: You probably received an Explanation of Benefits (EOB) statement. This statement is not a bill; it explains what services your dentist provided and how Delta Dental processed and paid for the services.

Q: What are predeterminations and are they mandatory?
A: A predetermination of benefits allows you to know in advance what procedures are covered, the amount your plan will pay toward treatment and your financial responsibility. Treatment plans are mandatory for orthodontic services. Treatment plans that involve prosthodontic services, individual crowns (except stainless steel), gold restorations, surgical periodontics, endodontics and oral surgery should be submitted to Delta Dental for predetermination of benefits. Please refer to your Benefits Booklet to for more information.

Q: Does my coverage run on a calendar year?
A: Yes, your coverage runs on a calendar year. For specific information on your benefits or benefit year, login to the Subscriber Connection. You can also check your Benefits Booklet or contact our Customer Service department at (800) 234-3375.

Q: What is a deductible?
A: A deductible is the annual amount you pay before the dental benefits are payable.

If you have additional questions, please contact us.

 

 

Learn More about Delta Dental Individual and Family Plans >>

 Learn More about Delta Dental Exchange Certified Plans >>