To get a quote for a Delta Dental Insurance Company plan, please fill out our request form on the home page.
Product Descriptors
DeltaCare® USA
DeltaCare USA® is a closed network plan that features set copayments, no annual deductibles and no maximums for covered benefits. Enrollees select a primary care dentist in the DeltaCare USA network from whom they receive treatment, as in a traditional dental HMO. In some states*, DeltaCare USA is offered as an open access plan where enrollees can obtain treatment from any licensed dentist; however, deductibles, co-insurance and maximums may be applied for services provided by an out-of-network dentist. For details about DeltaCare USA plans in these states, contact your local Delta Dental representative.
*Mississippi, Louisiana and Montana
Delta Dental PPOSM
Delta Dental PPOSM is an open network plan that allows enrollees to visit any licensed dentist. Enrollees usually pay the least when they visit a contracted dentist in the low cost PPO network. Enrollees who wish to visit a non-PPO dentist may choose either a moderate cost Premier network dentist or a dentist that does not contract with a Delta Dental network.
* In Texas, Delta Dental Insurance Company offers Dental Provider Organization (DPO) plans.
About Delta Dental
Our Enterprise
Delta Dental is committed to delivering quality, comprehensive dental programs to enrollees and clients that sponsor group benefit coverage. As a dental specialist, Delta Dental puts the focus on delivering affordable dental care, making the best use of benefit dollars and improving enrollees’ access to improved oral health.
As part of the largest dental benefits delivery system in the U.S., Delta Dental offers multi-state products with single-site claims administration and locally contracted dentist networks. Our Delta Dental enterprise covers 33 million people in the U.S., Puerto Rico and the District of Columbia. Enrollee retention exceeds 95% annually, demonstrating a high level of satisfaction with the benefits and service provided.
68 million enrollees trust their smiles to Delta Dental!
Delta Dental of California, Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with affiliate companies and Delta Dental of New York, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. These companies are members or affiliates of members of the Delta Dental Plans Association, a network of 39 Delta Dental companies that together provide dental coverage to more than 68 million people in the U.S.
Delta Dental’s expertise
Because it provides a single-line (dental) of healthcare coverage, Delta Dental’s customer service system is designed specifically for the administration of dental benefits. By focusing only on dental benefits, Delta Dental is able to provide the effectiveness, quality, and customer service that many other carriers and dental plans cannot provide for their dental programs.
Networks
Our Networks
Delta Dental provides access to one of the largest national dental networks. Four out of five dentists nationally agree to limit their fees to Delta Dental’s contracted allowances when treating Delta Dental enrollees. Delta Dental’s network access and cost management practices can save clients and enrollees in premiums or claims liability and patient out-of-pocket costs.
Credentialing
Delta Dental credentials dentists before they can be admitted into their networks. The credentialing process includes obtaining current dental credentials including state license, evidence of malpractice coverage, DEA certificate, specialty training verification, and an application. Delta Dental reviews malpractice history and state board actions. Dentists are required to complete an application that includes a practice history and indicates compliance with current Centers for Disease Control Infection Control Guidelines.
SmileWaySM Wellness Program
As experts in dental benefits, Delta Dental recognizes the ongoing need to promote wellness resources and make content and tools visible and accessible.
Delta Dental’s SmileWaySM Wellness Program includes enhanced oral health communications, new features on our website, an expanded online presence promoting oral health through channels such as Facebook and Twitter and a new three-part “Oral Health Challenge,” that includes customized communications to participants in our cavity and periodontal risk assessment quizzes based on their results.
Claims and Service
Customer Service
Delta Dental’s customer-responsive approach addresses every aspect of the customer experience: accurate claims processing, ease of use and personalized service.
Delta Dental uses a work management and call-tracking system to log and track customer inquiries. As part of the quality monitoring program 100% of incoming customer service phone calls are recorded. Delta Dental can see the call history by enrollee and create both summary and detailed reporting on a client-specific basis. This continuous commitment to quality and convenience delivers exceptional service to clients and enrollees alike.
Delta Dental’s comprehensive staff training programs include regular training sessions, call monitoring and formal assessments to ensure customer service and claims representatives meet quality assurance program standards.
Claims Processing
Delta Dental processes more than 42 million claims per year. On average, each claim is processed in four days or less with an average of 99% accuracy. Approximately 66% of claims submitted are sent electronically. Of these, 89% clear routing eligibility edits and are automatically adjudicated. Remaining claims are reviewed by the appropriate departments, such as dentist consultant review, and are adjudicated within five to seven days.
Highlights of Delta Dental’s claims administration include:
- Paperless claims – incoming claims are imaged and routed for processing with Optical Character Recognition Software
- Electronic claims and x-ray submission capabilities
- Single site claims processing with unified processing policies and administration
Quality Assurance
Delta Dental maintains a dedicated quality assurance program that ensures claims processing accuracy and adherence to agreements from network dentists.
Daily quality assurance checks are performed to resolve problems before customers are affected. Verification of the accuracy of eligibility data, system coding, data entry and contracted fees are performed routinely and cross checked against the system and client contract files.
Delta Dental also has dentists on staff to review claims submitted with complex treatments, establish policies and processing guidelines and consult with the treating dentist when necessary.
Regional dentist consultants offer independent second opinions for quality and clinical issues at no cost to the patient. If treatment does not meet quality of care standards, enrollees are protected for both treatment and financial liability.
In addition, Delta Dental performs random on-site assessments of network dental offices and uses a comprehensive utilization review system that monitors and compares dentists within a geographical area to indicate aberrant dentist practice patterns. If necessary, additional review and/or corrective actions are recommended by the Quality Assessment committee.
Online Resources
Tools and Services
Delta Dental is dedicated to continuous technical improvements that positively affect administrative efficiency and customer experience, while providing enrollees with user-friendly self-service options.
Features available on Delta Dental’s website, deltadentalins.com, and Spanish-language website, es.deltadentalins.com, include:
- Search for network providers with maps and driving directions to dental offices
- Smartphone optimization of our most frequently used features for convenience on the go
- Online benefits and eligibility information
- ID card pdf and printing capability, plus smartphone ID card optimization
- View claims status and claims history
- Secure online forms for submitting inquiries or complaints
- Option to suppress receipt of printed claim documents
- Option to elect email alerts when claim documents are available
- Fee Finder, a tool that allows lookup of average cost of common dental procedures in a specific area
- Downloadable claim forms
- Grin!, an e-newsletter provided through SmileWay® that keep enrollees up to date on the latest dental health information
- SmileWay Wellness Program, an oral health communications and website feature. Enrollees can complete cavity and periodontal risk assessment quizzes, opt in for targeted communications and obtain oral health tips and education.
- MySmileKids.com, Delta Dental’s website for kids in English and Spanish
Small Business Plans
Delta Dental’s program for small business is specifically designed to meet the needs of small and fast-growing companies; providing the same quality coverage, superb network access and basic features that are available to larger companies. Several Delta Dental PPOSM, Delta Dental Premier®, and DeltaCare® USA plans are available to employers with as few as 5 full-time, permanent employees (2 in NY & TX; 3 in GA & FL). Whether you have just a few employees or a hundred, Delta Dental’s Small Business Program dental plans are convenient, easy to use, and offer comprehensive coverage.