Frequently Asked Member Questions



What is a dental plan?

Understanding your dental benefits can help you receive appropriate and cost-effective care. Our easy-to-read brochure will provide you with a clearer understanding of this important benefit. [Return]

Do I need my identification (ID) card when I get care?

If you have an ID card, show it to your dentist at each visit so a proper claim can be filed for your dental services. Otherwise, supply your group name, group number (if you know it) and your ID number/Social Security number. To find a participating dentist, please visit our Find a Dentist tool. [Return]

What if someone in my family has another dental insurance plan? How does Coordination of Benefits (COB) work?

When someone has additional dental coverage, one plan is usually primary. Your dentist will send the claim for service to the primary insurance plan and may also submit it to a secondary plan. In this case, Delta Dental will coordinate benefits. Refer to your benefit booklet for your plan’s specific provisions.  [Return]

What is an Explanation of Benefits (EOB)?

This is a document you receive from Delta Dental after you visit the dentist. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your dental plan. Though EOBs vary across Delta Dental member companies, they should include the dentist's fee, the portion Delta Dental paid and any amount you may owe (such as deductible, coinsurance or non-covered services). It should also include an update on how much of your annual maximum has been used and the amount you've paid toward your deductible.[Return]

Can I change dentists?

Yes. Requirements for changing dentists vary by plan; refer to your benefit booklet for your plan’s specific provisions. [Return]

How do I know which dentist to select?

Ask friends, neighbors, co-workers and family to find a dentist who matches your needs and values. A convenient location and clinic hours, possibly including Saturday and evening hours, may also be important considerations. [Return]

Do I need to verify that my dentist is a Delta Dental participating dentist?

Yes. By checking with your dentist or Delta Dental Customer Service (see the back of your ID card for the phone number), you are assured that your dentist is participating in one of our networks. Consult your benefit booklet for more information regarding your specific plan design. We suggest you verify a dentist’s participation status with Delta Dental or your dental office before each appointment. [Return]

What are the advantages of using a Delta Dental participating dentist?

A Delta Dental participating dentist has signed a participating and membership agreement with Delta Dental. The dentist has agreed to accept our allowable charge as payment in full for covered dental care. A participating dentist is not allowed to bill more than our allowable charge. A Delta Dental participating dentist will also file the claim directly with us. We will make payment directly to the participating dentist and you will receive an explanation of benefits detailing your financial responsibility for any deductible or coinsurance amounts. [Return]

Can I see an out-of-network dentist?

Yes, you may seek services from a non-participating (out-of-network) dentist: Reimbursement for the services will be paid directly to you, and you are responsible for paying your dentist. A non-participating dentist does not have a requirement to accept our allowable charge so you may share in more of the cost for your care. You are responsible for paying your dentist up to the dentist’s full-billed amount. [Return]

What username should I use when signing into the system?

Use the username you created during the registration process. Note, the username field is separate from the subscriber ID field, which uses your subscriber ID or Social Security number. [Return]

How are dental benefits affected if my dependent child is ill or injured and can no longer attend school on a full-time basis?

Under Michelle’s Law, if an unmarried dependent child who was attending a postsecondary educational institution on a full-time basis and is currently covered under the parent’s dental benefit policy becomes seriously ill or is injured, he/she may continue to be covered. In order to remain covered, a physician must provide written documentation supporting the need for a medical leave.

For details, access:

Michelle’s Law Disabled Dependent/Michelle’s Law Application [Return]