Insurance - Dental

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5. Dental Insurance

Summary of Dental Benefits

Delta Dental
Annual Deductible	$25 per person
Diagnostic & Preventive Services, exams and cleanings (once every 6 months); x-rays	70% of Allowable Charges
Basic Restorative Services, fillings and repairs	70% of Allowable Charges
Oral Surgery, Periodontics, Endodontics (root canals)	50% of Allowable Charges
Major Restorative Services, crowns, dentures, after 12 month waiting period	50% of Allowable Charges
Orthodontic Services, after 12 month waiting period, maximum benefit age applies*	50% of Allowable Charges; $1,000 Lifetime
Annual Benefit Maximum (per person)	$1,000, not including orthodontic benefits

* Orthodontics are defined as all the necessary procedures of treatment by a licensed dentist for correction of mal-positioned teeth of an eligible dependent child, limited to payment of quarterly or other periodic charges through completion of treatment or to age 19, or to the date eligibility terminates, whichever occurs first.

Declination of Dental Insurance

Dependent dental coverage is available only if the dependents are also covered by the State medical plan. You may decline dental coverage for your family. To decline dental coverage for your family, employees must complete a Dental Declination form. The effective date is the first of the month following the declination. After declining, you may only add your family to dental coverage when there is an open enrollment for dental. There may be several years between open enrollment periods for dental.

Participating Providers

You can use any provider you want, but you may save money when you use providers who belong to the State plan network. Most benefits are paid based on Allowable Charges, which means they’ll accept plan benefits plus your share (any deductible, coinsurance or co-payments) of the costs as payment in full.

Non-participating Providers may charge more than the plan’s Allowable Charges, which means you are responsible for any amounts that exceed the Allowable charges plus any deductible and coinsurance amounts. An exception may be made when you have to use a non-participating provider for an emergency or because a non-participating provider is the only source of services.

To find Participating Dental Providers, please contact Delta Dental Plan of Idaho, 1-888-333-3582 or go on-line http://www.deltadental.com/ Go to “Searching for a Dentist?” then select Delta Premier and follow the screen prompts.

Filing Claims

After you enroll, you will receive an identification card from Delta Dental Plan of Idaho. Whenever you receive services from a participating provider, just show your ID card. The provider will bill the plan on your behalf. When you use a non-participating provider, you may have to make a claim for reimbursement. Submit a detailed invoice from your provider. Be sure to include your name, subscriber identification number and the name of your employer to the following address:

Delta Dental
PO Box 2870
Boise, ID 83701

Contact Information

We recommend you contact the carrier prior to having any services performed.

General Information:

State of Idaho’s Office of Insurance Management, http://www2.state.id.us/adm/insurance/group_index.htm

1-800-531-0597, 332-1860, ogi@adm.state.id.us

Dental Plan:

Delta Dental, http://www.deltadentalid.com

1-800-718-3374 or 1-208-344-4546

Human Resource Services, Boise State University