Whether you choose coverage under the Delta Dental Plus or Delta Dental Basic option, the dental plan offers discounts if you use a dentist participating in the Delta Dental (Delta) network. You’ll generally pay less, because participating dentists have agreed to provide services at discounted rates. You’ll also be able to receive services from dentists who don’t participate in the network, although your out-of-pocket payments will generally be more.

In addition, you should know the following about Delta Dental coverage:

• What is a Delta participating dentist? In order for dentists to participate with Delta Dental, they must first profile dental fees for all procedures. If the fees are consistent with Delta’s reasonable and customary levels, the dentist is invited to participate. A participating dentist may not charge a Delta participant an amount that exceeds the fee that has been filed. Therefore, if you use a participating dentist, the problem of being billed for the difference in what a dentist charges and what the dental plan considers to be reasonable and customary for a particular procedure cannot occur.
• Are there any other advantages to using a Delta participating dentist? Yes. Participating dentists have Delta claim forms in their offices. They will file the claim directly to Delta for you. In turn, Delta will pay the dentist directly. You’re responsible for paying the deductibles and coinsurance.
• May I still use a dentist who doesn’t participate in the Delta Dental network? Yes. Delta will process the claim using the same plan provisions. The benefit payment, however, will be sent to you, and not the dentist. You’ll be responsible for paying the dentist.
• Are claim forms necessary? Yes and no. Our dental plan still requires claim forms. Delta participating dentists, however, will have claim forms and will file the claim directly with Delta for you. In fact, many Delta dentists file claims electronically without the use of claim forms. If your dentist isn’t a Delta participating dentist, claim forms are available from HRConnect at www.ynhhs.org/hrconnect.
• How can I find the names of Delta participating dentists? Call Delta at 1-800-335-8265 for the most current information on participating dentists in your area. In addition, a list of participating dentists is available online at deltadentalnj.com.
• Does Delta Dental have a toll-free member services number I can call if I have questions about my dental coverage? Delta’s automated voice response system is available for your use 24 hours a day. By calling 1-800-452-9310, you can obtain information about eligibility, benefit plan provisions, or the status of a claim. If you’d like to speak to a Benefit Services representative, call the voice response system and enter “*.” Delta representatives are available to answer any questions you may have from Monday through Friday, 8:00 a.m. to 6:30 p.m. Eastern Standard Time.