Delta Dental PPO plus Premier Network
You will get the best value from your Delta Dental Plan when you receive your dental
care from one of our PPO (greatest savings) or Premier network participating dentists:
¥ No Balance Billing: Because participating dentists accept Northeast Delta Dental's
allowed fees for services, you will typically pay less when you visit a participating
dentist.
No Claims Paperwork: Participating dentists will prepare and submit claims for you.
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x Direct Payment: Northeast Delta Dental pays participating dentists directly, so you
don't have to pay the covered arnount up front and wait for a reimbursement check.
To find out if your dentist participates in our PPO or Premier network, you can: call your
dentist, visit our website at nedeita.com, or call Customer Service at 1-800-832-5700.
Claim Process for Participating Dentists
Your participating dentist will submit your claim to Northeast Delta Dental (claims for
any of your covered dependents should be submitted under your Subscriber |D number).
Northeast Delta Dental will produce an Explanation of Benefits (available through our
Benefit Lookup site at nedelta.com) detailing what has been processed under your plan's
coverage. You are responsible to pay any outstanding balance directly to the dentist.
Non-Participating Dentists
If you visit a non-participating dentist, you may be required to submit your own claim
and pay for services at the time they are provided. Claim forms are available by visiting
nedelta.com or by calling Northeast Delta Dental. Payrnent will be made to you, the
Subscriber, unless the state in which the services are rendered requires that assignment
of benefits be honored and Northeast Delta Dental receives written notice of such
assignment. Payment for treatment performed by a non-participating dentist will be
limited to the lesser of the dentist’s actual submitted charge or Delta Dental’s allowance
for non-participating dentists in the geographic area in which services are provided. It is
your responsibility to make full payment to the dentist.
Predetermination of Benefits
Northeast Delta Dental recormmends that you ask your dentist to submit a pre-treatment
estimate for any dental work involving costly or extensive treatment plans.
Predeterminations helps avoid any potential confusion and enable us to help you
estimate any out-of-pocket expenses you may incur.
Coordination of Benefits
When an individual covered under this plan has additional group coverage, the
Coordination of Benefits (COB) provision described in your Dental Plan Description
booklet will determine the sequence and extent of payment. If you have any questions
about COB, please contact our Customer Service Departrnent at 1-800-832-5700.
Identification Cards
Two identification cards will be produced and distributed shortly after
your initial enrollment. Both cards are issued in your name but can be [=]
used by any family member covered under your plan. Any future c
cards will be issued electronically via our Benefit Lookup site
accessible through nedelta.com. You can also use our smartphone
app and enjoy access to dentist search, claims and coverage, and your [a]
1D card. Simply scan the QR code to the right.
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Health through Oral Wellness’ (HOW)
A healthy mouth is part of a healthy life, and Northeast Delta
Dental's innovative Health through Oral Wellness program
(HOW) works with your dental benefits to help you achieve and
maintain better oral wellness. HOW is all about YOU because it's
based on your specific oral health risk and needs. Best of all, it's
secure and confidential. Here's how to get started: HEALTH sreugé
1. REGISTER ORAL WELLNESS"
Go to healththroughoralweliness.com and click on “Register Now.”
2, KNOW YOUR SCORE
After you register, please take the free oral health risk assessment by clicking on “Free
Assessment” in the Know Your Score section of the website.
3. SHARE YOUR SCORE WITH YOUR DENTIST
The next step is to share your results with your dentist at your next dental visit. Your
dentist can discuss your results with you and perform a clinical version of the risk
assessment. Based on your risk, you may be eligible for additional preventive benefits.*
‘Additional preventive benefits are subject to the provisions of your Northeast Delta
Dental policy.
Dental Pian Description Booklet
The Dental Plan Description booklet will be available shortly after your enrollment. This
benefit booklet describes your dental benefits and explains how to use them. Please
read it carefully to understand the benefits and provisions of your Northeast Delta
Dental plan.
Who is Eligible?
You, your spouse (or Civil Union Partner in states where applicable), your children up to
age 26, regardless of student status, and any incapacitated dependent children,
regardless of age. If enrolling one eligible dependent, all of your eligible dependents
must be enrolled, unless they are covered under another denta! program.
Renewability
Your plan will automatically renew for a new twelve (12) month Plan Year if the
premium continues to be paid. Premiums are subject to change annually in accordance
with advance notice. You or Northeast Delta Dental may choose not to renew this plan
upon advance notice, The plan will not be renewed if this dental program is no longer
available.
THIS INFORMATION SHOULD BE USED ONLY AS A GUIDELINE, FOR DETAILED
INFORMATION ON THE TERMS, CONDITIONS, LIMITATIONS AND EXCLUSIONS,
PLEASE REFER TO THE APPROPRIATE DENTAL PLAN DESCRIPTION.
