 InsuranceCompany.com
an affiliate of Del Amo Insurance Services, Inc., through its' brokerage
services, can arrange dental benefits with the Delta Dental Plan
Association, is a specialist in dental insurance, dental discount plans,
vision and prescription coverage programs throughout the United States. We
offer several national dental insurance, vision and prescription programs
with membership in its dental insurance and/or discount plans depending
upon the state you live in.
InsuranceCompany.com is a marketing
affiliate and a wholly owned subsidiary of Del Amo Insurance Services,
Inc., a California corporation, license #0B93601 DBA: InsComp Insurance
Services, an agent of Delta Dental PMI in California, Florida, Texas,
Utah; and MWG in Alabama, Delaware, Washington DC, Florida, Georgia,
Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania,
Texas, Utah, West Virginia. All Delta Dental products are registered
trademarks or service marks of Delta Dental Plans. Click
here for Delta Dental©
Copyright Information.
For assistance with
your current Delta
Dental Plan policy please refer to
DeltaDental.com.
DeltaCare programs provide
rigorous controls to assure quality care. Network dentist undergo on-site
quality audits. Auditors examine office hours, number of staff members,
convenience of location, sterilization techniques, recordkeeping,
opportunities available to staff, type of equipment, continuing education,
range of services provided and the dentist's own quality assurance system.
Contracted dentists must have been in practice for at least five years and
must be able to provide 24-hour emergency service. Once accepted into the
network, the dentist's office is visited regularly by a DeltaCare
representative.
The
DeltaCare panel includes oral surgeons, endodontists, pedodontists,
periodontists and orthodontists. When a DeltaCare primary care dentist
refers a patient to a specialist, the DeltaCare program reimburses the
specialist directly for prior authorized treatment. Unlike many managed
care dental programs, DeltaCare doesn't require the primary care dentist
to pay for specialty care, a practice which encourages appropriate
referral. (The patient pays the same copayment for specialty care services
whether performed by the primary care dentist or by a referred
specialist.)
DeltaCare offers a broad
range of covered benefits:
All services are covered in
full or with patient co-payments as shown in the schedule of benefits and
co-payments.
-
Diagnostic and preventive services,
including examinations, consultations and x-rays. Also included are
prophylaxis (cleaning), topical application of preventive solutions and
sealants (age limitations may apply) and space maintainers.
-
Emergency services,
to relieve pain and infection.
- Restorative
services,
including amalgam, porcelain and plastic restorations (fillings) for
treatment of carious lesions (visible destruction of tooth surface
resulting from the process of decay). Crowns and jackets are also
covered when teeth cannot be restored with the materials mentioned
above.
- Oral surgery,
including extractions and certain other surgical procedures.
- Endodontics,
including pulpal therapy and root canal filling.
-
Periodontics,
treatment of the tissue supporting the teeth.
-
Fixed bridges,
covered subject to administrative policies.
- Removable
prosthetics,
including full or partial dentures.
-
Orthodontic care,
for adults and/or dependent children, subject to the availability of
network orthodontists.
DeltaCare dentists receive
a predetermined amount each month for each patient enrolled with their
office. Because these dentists have already contracted to provide services
to DeltaCare patients, there are no claim forms.
Limitations on
all Benefits - Optional Services:
Services that are more
expensive than the form of treatment customarily provided
under accepted dental practice standards are called
"Optional Services." Optional Services also include the use
of specialized techniques instead of standard procedures.
For example: a crown where a filling would restore the
tooth, a precision denture where a standard denture could be
used, or an inlay instead of a restoration. If you receive
Optional Services, your Benefits will be based on the lower
cost of the customary service or standard practice instead
of the higher cost of the Optional Service. You will be
responsible for the difference between the higher cost of
the Optional Service and the lower cost of the customary
service or standard practice.
Exclusions
Delta Dental does not pay Benefits for:
a) Services for injuries or
conditions which are compensable under workers' compensation
or employers' liability laws; services which are provided to
the Enrollee by any federal or state government agency or
are provided without cost to the Enrollee by any
municipality, county or other political subdivision except
as such exclusion may be prohibited by law.
b) Services with respect to
congenital (hereditary) or developmental (following birth)
malformations or cosmetic surgery or dentistry for purely
cosmetic reasons, including but not limited to cleft palate,
maxillary and mandibular (upper and lower jaw)
malformations, enamel hypoplasia (lack of development),
fluorosis (a type of discoloration) of the teeth, and
andontia (congenitally missing teeth), except those services
provided to newborn children for congenital defect or birth
abnormalities or services that may be provided under
Orthodontic Benefits.
c) Services for restoring
tooth structure lost from wear, erosion, or abrasion, for
rebuilding or maintaining chewing surfaces due to teeth out
of alignment or occlusion, or for stabilizing the teeth.
Such services include, but are not limited to:
equilibration, periodontal splinting, occlusal adjustment.
d) Any Single Procedure
started prior to the date the person became covered for such
services under this program.
e) Prescribed drugs,
medication or analgesia.
f) Experimental procedures.
g) Charges by any hospital
or other surgical or treatment facility and any additional
fees charged by the Dentist for treatment in any such
facility.
h) Charges for anesthesia,
other than by a licensed Dentist for administering general
anesthesia in connection with covered oral surgery services.
i) Extra oral grafts
(grafting of tissues from outside the mouth to oral
tissues).
j) Services with respect to
any disturbance of the temporomandibular joint (jaw joint).
k) Services performed by
any person other than a Dentist or auxiliary personnel
legally authorized to perform services under the direct
supervision of a Dentist.
l) Replacement of teeth
extracted prior to the member's effective date.
The preceding information is a brief description of
coverage. Contact Benefits Association for complete details.
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