Prospective member FAQs

PPO plans help you pay for the care you receive from your dentist. When you see a dentist in your network, you will pay a lower price for covered procedures and Delta Dental pays some of that price. Even if you see a dentist that’s out of your network, Delta Dental will still help pay for covered procedures, although you’ll enjoy more savings at a Delta Dental dentist.

DHMO-type plans have fixed prices for procedures, known as copays. DHMO-type prices tend to be lower, but you’ll only enjoy the coverage at your chosen DeltaCare USA dentist. Staying in network is a required part of your DeltaCare USA plan.

Delta Dental PPO™ individual plans are available in AL, CA, DE, FL, GA, LA, MD, MS, MT, NV, NY, PA, TX, UT, WV and DC.

DeltaCare® USA individual plans are available in CA, FL, MD, NV, NY, PA, TX, UT and DC.

Live in a state that isn’t listed? See the individual dental insurance plans available to you.

When you enroll in an individual Delta Dental plan, you can pay your premium directly to Delta Dental. We accept the following payment methods: bank account debit (also known as Automated Clearing house or ACH), credit card and check.
 
You can also set up autopay with your bank or credit card.

A dental benefit waiting period is the amount of time after purchasing a dental insurance plan that you must wait before you are eligible to receive benefits for treatment. Waiting periods differ from plan to plan, but there is typically no waiting period for preventive or diagnostic services such as routine cleanings and basic exams.

Your dental plan may have a 6- to 12-month waiting period for restorative services such as filings and non-surgical extractions, where a 12-month waiting period is often standard for major services such as crowns or dentures. If you receive services during a waiting period, your dental coverage may not pay for them.

In certain cases, a waiting period will be waived if a comparable dental insurance plan was terminated in the 30 to 60 days prior to the effective date of your new plan, but your former dental plan must include very similar coverage.

While you don't need an ID card to receive services for insured members, you can still get one by logging in or creating an online account. From there, you can email or print a copy of your membership ID card.

If you purchase an Individual Delta Dental plan and choose to receive communication through the mail, you'll receive one paper ID card in the policy holder's name as part of your welcome package. Additional family members on the account can use the same information from the card.

You’ll receive one ID card in the policy holder's name. Additional family members on the account can use the same information from the card.

While an ID card is not required to receive services for insured members, some dentist offices still ask for it. Your dentist’s office staff can use your ID card to quickly look up your benefit and coverage information.

If you don't have your ID card with you, your dentist can look you up with other identifying information, such as your name, address and Social Security number.

Yes. Delta Dental offers ACA-compliant dental plans in 15 states, plus D.C., including pediatric-only plans and options for families.

Plans on the Health Care Exchange (Marketplace) are categorized as high coverage and low coverage. A high coverage plan means you’ll pay a little more each month (in premiums), but you’ll owe the dentist less for covered services (and more may be covered, depending on your plan). With a low coverage plan, you’ll pay a little less each month (in premiums), but you’ll owe the dentist more for covered services.

Beyond offering you high and low dental coverage options for children and families, you can also choose between a PPO and copay plan.

Delta Dental PPO™
 

• Our coinsurance plan shares your costs for covered services.
• After you meet your annual deductible, Delta Dental pays a percentage of your bill and you pay the rest.
• You can visit any dentist, but you’ll save the most with a Delta Dental PPO dentist.
• Children can use their benefits immediately — adults may have a waiting period for Major Services.

   

DeltaCare® USA
 

• Our copay plan works like a dental HMO.
• You must visit your selected DeltaCare USA dentist to receive benefits.
• When you visit the dentist, just pay your predefined copayment and you’re all set.
• You’ll know all copayments up front, so you can plan ahead for treatment costs.
• Use your benefits right away — there’s no waiting period on children or adult services.

Simply visit Healthcare.gov or your state's exchange website (e.g., Covered California) to view the dental plan options available to you and choose a plan.

In most states, open enrollment for individual plans on the Health Care Exchange (Marketplace) starts on November 1 to obtain dental insurance for the new year. Check healthcare.gov for exact open enrollment dates for your state.

If you’re already a Delta Dental member, you should be set with your current group coverage. For questions about your employer plan, reach out to your company’s benefits representative.

Yes.

Rules vary by state. Please refer to Healthcare.gov for exact information on buying stand-alone dental coverage in your state.

Anyone can enroll in a Delta Dental individual plan year-round. Plan eligibility requirements vary by state. For eligibility requirements related to your state and plan, refer to the plan Policy and Benefit Details document.

Yes, you can enroll anytime.

Delta Dental PPO plans have flexible enrollment options—you can choose from four effective (start) dates when you purchase your plan. The dates are based on the plan purchase date:
 

• Plans purchased from the first through the 14th of the month have effective date options of the 15th of the current month, the first of the next month, the 15th of the next month or the first of the month after next. For example, a plan purchased on July 3 can be effective July 15, August 1, August 15 or September 1.
  
• Plans purchased on or after the 15th of the month have effective date options of the first of the next month, the 15th of the next month, the first of the month after next or the 15th of the month after next. For example, a plan purchased on July 15 can be effective August 1, August 15, September 1 or September 15.
  
  

DeltaCare USA plans have a set effective date based on the plan purchase date:
 

• Plans purchased by the 21st of the month will become effective on the first date of the following month. For example, a plan purchased on June 17 would become effective on July 1.
• Plans purchased after the 21st will not be effective until the month after the next. For example, a plan purchased on July 25 would not be effective until September 1.

This is an administrative fee for processing your application. The fee is charged at the time of enrollment for residents of AL, CA, DE, FL, GA, LA, MD, MS, MT, NV, PA, TX, UT and DC and is non-refundable.

There’s no additional application fee for qualifying dependents. For example, a primary enrollee with five dependents pays $10 at the time of enrollment, not $60.

Check to see if your dentist is in your DeltaCare USA network. You can use our Find a dentist tool (or log in to your account) to search your DeltaCare USA network by your dentist's name or the practice name.

If the dentist is in your network, before you schedule an appointment, you'll need to log in to select your dentist's facility as your primary care facility¹. If your dentist is not in the network, you'll need to find a new dentist at your selected facility, or search for a new facility by logging in to your account.

1. Visit our Find a dentist page.
2. Enter your address, city or ZIP code.
3. Select the network for your preferred plan: either Delta Dental PPO or DeltaCare USA. You’ll likely save the most if you choose the Delta Dental PPO network for the Delta Dental PPO plan and the DeltaCare USA network for the DeltaCare USA (DHMO) plan.
4. Select Find a dentist.
5. You can also add optional keywords to narrow your search.
   
   

When you purchase a Delta Dental plan, you’ll have the option to create a Delta Dental account during checkout. You can also register for an account 24 hours after you purchase your plan — visit the Delta Dental online account log in page to get started.

You can use your Delta Dental account to manage your plan, review benefit details, find a dentist, check claim status, pay premiums and locate your member ID card.

Yes. After you purchase a plan, you’ll have up to 60 days from the plan effective date to make changes. Note that some changes may affect your plan rate.

For a complete description of plan benefits, limitations and exclusions, refer to the plan Policy and Benefit Details document.

Yes. After you purchase a plan, you’ll have up to 60 days from the plan effective date to add your spouse and any dependents up to age 26.