Dental Benefits

Delta Dental

The Fund’s dental Plan is the Delta Dental PPO Plus Premier. The Fund gives you access to Delta Dental’s PPO and Premier networks.

• Delta Dental administers the Fund’s dental benefits.
• Delta Dental has the largest network of participating dentists in the country.
• More than 400,000 dentists nationwide participate in Delta Dental’s networks.

When you need dental care, simply visit a participating dental provider to receive the most out of your benefits.

Paying for Benefits

• You pay for covered services by paying coinsurance.
• The amount you pay also depends on if you visit a in-network or out-of-network provider. You typically pay less when you visit an in-network provider.
• Out-of-network providers may use “balance billing,” which permits dentists to bill you for the difference between the plans negotiated rate and the full amount charged for services.
  • Example: Delta Dental Plan covers 100% of preventive care, such as annual or semiannual visits for cleanings. Suppose the customary fee of a procedure in the preventive care category is $100 and the insurance plan approves $80. An in-network dentist cannot bill the patient the difference of $20, because of the negotiated rate between Delta and the provider. An out-of-network dentist can “balance bill” the patient for their full fee and collect the $20 difference.
• You must first meet the Plan’s deductible before you get benefits.
• There is a calendar year maximum. The Fund will pay benefits up to the maximum.
• There is a lifetime maximum for orthodontic services (braces). This is in addition to the calendar year maximum.

For more information, log in to your account at Delta Dental’s website.

To find a participating dental provider, such as a dentist or orthodontist, visit Delta Dental’s website.

You can search for dental providers by name or address. Remember to search for providers in the Delta Dental PPO or Premier networks.

You can also call Delta Dental’s Customer Service at at (800) 872-0500.

The Fund’s dental benefits cover many types of dental care:

• Diagnostic and Preventive
• Restorative
• Oral Surgery
• Periodontics
• Endodontics
• Emergency Orthodontics

You can download the full schedule of dental benefits to see how much you pay for most services.

• Schedule of Dental Benefits

You can also download the Delta Dental Member Guide.

For more information, log in to your account at Delta Dental’s website.

In-Network Providers

• When you visit a dental provider who participates in the Delta Dental PPO or Premier networks, they will submit claims for you.
• All you have to do is show up to your appointment and your dentist’s office will handle the rest.

Out-of-Network Providers

• Dental providers who do not participate in the Delta Dental networks will require you to fill out and submit a Delta Dental Claim Form.
• Your provide can give you a copy of the claim form.
• You pay the provider’s cost at the time of your service.
• You are reimbursed for part of the cost after you submit your claim to Delta Dental. Out-of-Network dentists may “balance bill” and subscriber are responsible for the difference between the out-of-network maximum plan allowance and the full fee charged by the dentist.
• Instructions for submitting the claim are on the claim form.