How to Obtain Dental Benefits
If You Have Other Dental Coverage
If you have other dental coverage, see Participating in Healthcare Benefits for information on how Coordination of Benefits with that coverage may impact your claims.
If You Use Participating Dentists
If you use a dentist who participates in Delta Dental Premier or Delta Dental PPO, the dentist will submit your claim and receive payment directly from Delta Dental. You will receive an explanation of benefits (EOB) showing the portion of the charges paid by Delta Dental and the amount you owe.
For participating dentists, claim payment is based on the Maximum Approved Fee for a covered service as determined by Delta Dental. Payment is based on the lesser of the fee charged or the maximum approved fee. Participating dentists agree not to charge you for any difference between their actual fee and the Maximum Approved Fee.
If You Use Non-Participating Dentists
In most cases, when you use a non-participating dentist, you are responsible for paying the dentist directly and filing a claim for reimbursement. You will receive payment from Delta Dental along with an explanation of benefits (EOB) form.
For non-participating dentists, benefits are based on Delta Dental's non-participating dentist fee for a covered service. Payment is based on the lesser of the dentist's submitted fee or Delta Dental's non-participating dentist fee. You are responsible for the difference between the claim payment amount and actual charges.
Coordination of Benefits
Coordination of Benefits (COB) is used to pay healthcare expenses when you are covered by more than one plan. See "If You Have Other Coverage" in the Participating in Healthcare Benefits section of this Benefits Summary for more information about COB provisions for the dental plan.