Coverage for Children

• I am divorced. What kind of documentation do I need to provide to Delta Dental to maintain the children's dental coverage?

  A parenting plan or statement of financial responsibility is required to verify which parent has primary coverage and which has secondary coverage for children.

• I am divorced. If my former spouse and I both have dental coverage, whose insurance covers our children first?

  It depends on who has financial health care responsibility and/or custody for the children. If a parent has primary health care responsibility for the children, their coverage will be primary. If parents have joint health care responsibility, the order of benefits is determined by who has custody. If both parents have joint health care responsibility and joint custody, the order of benefits is determined by the parent with the birthday earliest in the calendar year as the primary carrier.

• If I am divorced and have physical custody of my children, does my former spouse's dental insurance still cover our children?

  If your former spouse has dental coverage that includes dependents, the children have coverage regardless of whether or not they reside with you or your spouse.

• Can we have more than two dental insurance policies for our children?

  Yes. In some cases children may be covered by more than two dental insurance policies. They may be covered by one or both parents, as well as one or more stepparents. If either parent's insurance policy has a "non-duplication of benefits" provision, the coverage will be subject to contract limitations.

Coverage Questions

• How often will my dental plan pay for me to have my teeth cleaned?

  How frequently your dental plan will pay for your teeth cleaning depends on the benefits  purchased by your employer. To learn about your specific coverage, Check Your Coverage. You will need to register or login to view.

• Do I have to get an “estimate” before having dental treatment done?
   If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, called a “confirmation of treatment and costs.” This allows you to know in advance what procedures may be covered, the amount Delta Dental may pay toward the treatment and your estimated financial responsibility. Please note that a confirmation of treatment and costs is not a guarantee of payment.
• I did not get an ID card. How will my dentist know I have coverage through Delta Dental?
   When you go to the dentist, the office staff will verify your eligibility for coverage and determine which dental benefits are available to you. You'll need to provide the dentist your personal information, group number, member identification number and insurance carrier name. If you would like an identification card, just sign in at the Delta Dental website. Your ID card will appear on your MySmile® personal benefits page. You can print out your paper ID card from there by clicking “print.”
• Does Delta Dental sell dental insurance plans to individuals?

  Yes. Please see Individual Plans for dental benefit plans.

• What does non-duplication of benefits mean?

  When you're covered by two dental policies, the non-duplication of benefits provision describes how a secondary policy may calculate its portion of payment. The secondary policy pays as much as it would pay if it were primary, minus the primary payment amount. For example, if the primary policy paid 80 percent and the secondary policy would cover 80 percent if it was primary, the secondary policy would not make an additional payment. If the primary policy paid 50 percent and the secondary policy would cover 80 percent, the secondary policy would pay up to 30 percent.

• Will my dental plan provide coverage if I need care when I am out of state?

  Delta Dental covers you nationawide. If you see a Delta Dental member dentist, they'll submit the claims for you; however, if you see a non-member dentist you're responsible for having the dentist complete and sign claims forms. You'll also need to submit the claims to Delta Dental. Payment is based on actual charges or Delta Dental's maximum allowable fees for participating Delta Dental dentist, which ever is less.

• Do I have to see a primary care dentist to get a referral to a specialist?
  For most Delta Dental plans, you may go to any dentist who is a member of the plan to which you belong. If you have chosen the DeltaCare plan however, you'll need to sign up for a primary care dentist by calling the DeltaCare Customer Service Department at (800) 650-1583.
• Why is there only one ID Card available online?
  The cards available online only list the subscriber on the card but can be used for all insured on the group.
• Are sealants covered on restored molars?

  Sealants are covered on permanent molars with no restorations or decay on the occlusal surface.  

• Why did Delta Dental pay less for white fillings on my back teeth?

  Your plan has an alternative allowance for fillings on your back teeth. If you have a white or tooth-colored filling placed on a back tooth, your plan will cover what a silver filling would cost. The difference in the cost between the silver and the white filling is your responsbility.

Delta Dental Plans Association

• Will other Delta Dental plans cover my dentist’s fees?
  Yes. Other Delta Dentals honor the approved fees that member dentists have on file with us.
• What is Delta Dental?

  Delta Dental Plans Association is a national organization made up of local, nonprofit Delta Dental plans that provide employer groups with dental benefits coverage in all 50 states, the District of Columbia and Puerto Rico.

General Questions

• How do I change my address with Delta Dental?
  Most employers do not allow address changes to be made directly through Delta Dental. Please first request this change through your employer. If you have a Delta Dental Individual Plan, please click on the the HDS link found on your Patient Home page after you've successfully logged in.
• May I choose my own dentist?

  Yes; you may choose your own dentist.  There are different networks to choose from, depending on which Delta Dental plan your employer has selected. To maximize the use of your benefits, see “Choosing a Dentist” in the “How to Use Your Program” section of your dental benefits booklet. You can find out whether your dentist is part of your plan’s network in the Find a Dentist section of this website. When you sign into the Delta Dental site and click on Find a Dentist, you'll see the dentists available in your plan network.

• What is my member ID number?
  Your member ID number is an unique number that identifies you as a Delta Dental subscriber under your dental plan. It may be your Social Security number or a randomly selected identification number that has been assigned.
• What is the mailing address for Delta Dental claims?
   If you see a Delta Dental member dentist, the dental office will submit your claims for you. If your dentist is not a member dentist, send your claims to:
             Delta Dental of Washington
             P.O. Box 75983
             Seattle, WA 98175
• Does it matter if I use all CAPS when registering on DeltaDentalWA.com?

  No; you should'nt have to use all CAPS to register. However, if you're having difficulty registering, you may try using all CAPS.

• How can I access my benefit information through the Delta Dental Interactive Voice Response System (IVR)?
  • Follow the IVR Phone Prompts to access the information you are looking for.
• Where can I find out-of-state dentists within the Delta Dental network?
  If you're searching for a dentist out of state, please use the DELTA DENTAL Find A Dentist by clicking here.  You can also find the link to the Delta Dental National Dentist directory under the Delta Dental Find A Dentist application - look for the green hyperlink called "Search the National Directory".
• How do I set my pop-up blocker settings?

  For Internet Explorer browsers:

  • Go to "Tools" in navigation
  • Select "Popup Blocker" settings
  • Add *.deltadentalwa.com and *.deltadental.com as trusted sites
  • Click Close button once trusted sites are added

  For Firefox browsers:

  • Go To "Tools" in navigation
  • Select "Options"
  • Click on "Content" in top navigation of the gray popup box
  • Click on "Exceptions" next to Popup Blocker
  • Add *.detladentalwa.com and *.deltadental.com as trusted sites
  • Click "Ok" to complete

Member Dentist Information

• What is the difference between a Delta Dental Premier® and Delta Dental PPO dentist?
  Delta Dental Premier is our traditional fee-for-service plan. All Delta Dental member dentists automatically belong to this network. Delta Dental PPO is our preferred provider plan and has the largest network of PPO dentists in Washington. PPO network dentists have agreed to provide care based on a lower average fee schedule. You can find out more about Delta Dental’s choice of products and plan designs on this Web site.
• What if I’m traveling out of state and need to see a dentist?

  Our Find a Dentist online dentist directory is linked to the Delta Dental Plans Association’s National Provider Directory where you can search for dentists outside of Washington state.

• How can I obtain a list of Delta Dental network dentists?

  You can obtain a current Delta Dental directory of dentists at Find a Dentist.

• What is a Delta Dental “member dentist?”
  A member dentist has signed an agreement stipulating that he or she will provide dental treatment to subscribers covered by Delta Dental's group dental care programs. Member dentists submit claims directly to Delta Dental for their patients.

Pre-treatment Estimates

• What is a pre-treatment estimate?
  A pre-treatment estimate, also known as a “confirmation of treatment and costs,” is a service that Delta Dental provides to its enrollees. A confirmation of treatment and costs is recommended for more extensive procedures such as crowns, wisdom tooth extractions, bridges, periodontal surgery, dental implants and dentures or if out-of-pocket expense is a concern. When your dentist confirms treatment with Delta Dental, you’ll receive an estimate of your share of the cost and how much Delta Dental may pay before treatment begins.
• How does it work?

  To confirm treatment, your dentist sends Delta Dental a proposed treatment plan, along with relevant X-rays. Delta Dental then checks to be sure which services are covered under your plan. Some dental work may be limited or excluded by your policy, and you will want to know what services may be covered before you proceed with treatment. We also calculate how any co-payments and dollar maximum limits might affect your share of the cost. You and your dentist then receive an estimate of the amount Delta Dental may pay for approved services and the amount you may be responsible for. Please note that a confirmation of treatment and costs is not a guarantee of payment.

Requests for Information

• How can I get approved claim forms?

  You can quickly download a claim form or you can obtain American Dental Association-approved claim forms from your dentist.

• What if I have questions about my dental benefits plan?

  If you have questions about your specific dental plan coverage, click on the Check Your Coverage link in the navigation bar at the top of your portal/MySmile home page. For clarification about your explanation of benefits form, click on Your Dental Activity in the top navigation bar.  If you still have questions, call Delta Dental’s Customer Service Department at (800) 554-1907 or e-mail cservice@deltadentalwa.com.

• What form do I need to view overage dependents information or if I am having custody issues?

  Please use the HIPAA Authorization form found here.