Download GET YOUR FACTS STRAIGHT on DeltaCare® USA

ORTHODONTIC BENEFITS:
GET YOUR FACTS STRAIGHT
DeltaCare® USA1
Preparing for orthodontic treatment under your DeltaCare USA plan?
Start by reviewing these FAQs. Then, log in to Online Services at
deltadentalins.com to review the details of your plan.2
GETTING STARTED
Do I need a referral to begin orthodontic treatment?
If you or your dependents live in California, you must get a referral from your primary
care dentist for orthodontic treatment. Outside of California, you do not need a
referral. In both cases, however, you will need to visit a DeltaCare USA orthodontist to
receive benefits.
How do I find a DeltaCare USA orthodontist?
Use the “Find a Dentist” tool at deltadentalins.com (or on our mobile app) to search
for a network orthodontist near you. Select “DeltaCare USA” as your network and
type “orthodontist” in the specialty/keyword field. You can also ask your primary
care dentist for a recommended orthodontist in the DeltaCare USA network or call
Customer Service for help.
1 DeltaCare USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental
of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MA, MI, NE, OR, RI, SC, WA, WI — Dentegra Insurance
Company; DC, DE, FL, GA, KS, TN, WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha
Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NM — Alpha Dental of New
Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania; VA – Delta Dental of Virginia. Delta
Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially
responsible for their own products.
DELTADENTALINS.COM/ENROLLEES
ORTHODONTIC COVERAGE
What’s covered?
Coverage varies depending on your plan,2 but most DeltaCare USA plans include:
• Pre-orthodontic treatment visit
• Exam and start-up records
•X-rays
• Comprehensive orthodontic treatment
• Orthodontic retention (retainers)
• Post-treatment records
It is less common for plans to cover: two-phase orthodontic treatment; appliances to
correct harmful habits, like thumb-sucking; and jaw surgery to facilitate orthodontic
treatment (as well as treatment to prepare for any non-covered surgical procedures).
Are retainers covered?2
Typically one set of post-treatment retainers (for orthodontic purposes) is covered. If
your benefits cover two-phase orthodontic treatment, retainers are usually covered
after each phase.
Is Invisalign® covered?
No. DeltaCare USA plans do not typically cover Invisalign or other specialty
appliances.2
MANAGING COSTS
How much will orthodontic treatment cost?
Costs depend on the services you need. At your first appointment, your orthodontist
will do a preliminary assessment and give you an initial estimate of costs. (This is
called a “pre-treatment estimate.”) If you agree to proceed, the orthodontist will
create a treatment plan and present you with the associated copayments and fees.
Find out your orthodontic copayment amount(s), by referring to the orthodontics
section of your plan booklet or logging in to Online Services at deltadentalins.com.
If I began treatment under a different dental plan, is work in progress covered?
Yes, if you are in active treatment (banding has taken place) under a previous
employer-sponsored dental plan and you continue to be eligible under a DeltaCare
USA plan, you can continue treatment with your current orthodontist. You will have
the same coverage and copayments as you had through your prior dental plan
(regardless of whether your previous plan was an open- or closed-network plan).
Coverage will continue as long as you remain eligible for coverage under a DeltaCare
USA plan.
Are claims required for orthodontic treatments?
No. Simply pay your copayment for covered services directly to your DeltaCare USA
orthodontist.
2 Your benefits may differ from the general information provided here. Review your plan booklet for specific details
regarding orthodontic coverage under your plan.
Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of
Pennsylvania, Delta Dental Insurance Company and our affiliated companies form
one of the nation’s largest dental benefits delivery systems, covering nearly 33
million enrollees. All of our companies are members, or affiliates of members, of the
Delta Dental Plans Association, a network of 39 Delta Dental companies that together
provide dental coverage to 68 million people in the U.S.
A proper preventive care routine is even more important
with braces. Learn more about taking care of your teeth
with preventive care tips on our SmileWay® Wellness site.
(mysmileway.com).
Good oral health is for the whole family! Check out our
kids’ oral health page: mysmilekids.com.
Copyright © 2015 Delta Dental. All rights reserved.
EF60_DCU_USA #82330 (rev. 7/15)
Our Delta Dental enterprise includes these companies in these states: Delta Dental
of California — CA, Delta Dental of Pennsylvania — PA & MD, Delta Dental of West
Virginia, Inc. — WV, Delta Dental of Delaware, Inc. — DE, Delta Dental of New York, Inc.
— NY, Delta Dental Insurance Company — AL, DC, FL, GA, LA, MS, MT, NV, TX and UT.
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