2022 Dental - Delta Dental
Whitfield County Schools offers two dental plan options with Delta Dental: Standard and Premium. The Standard plan has lower rates and a lower annual maximum with no orthodontia coverage. The Premium plan has a higher premium and annual maximum and includes orthodontia coverage. Both plans have the same coinsurance and deductibles, and dependent children can be covered up to age 26 regardless of student status.
As long as you access a PPO or Premier network provider, your claim will be processed at the in-network level with no balance billing. Services not covered or that exceed the calendar year maximum are the patient’s responsibility.
The PPO network is the largest and has the best discounts. We encourage you to use a Delta Dental PPO provider in order to maximize your dental plan benefits. Access www.deltadental.com to locate participating dental provider information. Refer to the Delta Dental benefits summary for complete details regarding frequencies and coverage information. Participating dentist information can be found on the Resources page.
Below is a benefit summary of your annual deductible and co-insurance costs.
| Delta Dental Coverage | Standard Plan | Premium Plan |
|---|---|---|
|
Deductible
|
$75 individual | $225 Family | $75 individual | $225 Family |
|
Type A - Preventive Services (Deductible Waived): Cleanings, exams, fluoride, bitewing x-rays, periodontal maintenance and more
|
Plan pays 100% | Plan pays 100% |
|
Type B - Basic Services (After Deductible): Fillings, simple extractions, sealants, full mouth x-rays, general anesthesia, and more
|
Plan pays 80% | Plan pays 80% |
|
Type C - Major Services (After Deductible): Periodontal surgery, scaling / root planing, crowns, bridges, dentures, pulp therapy
|
Plan pays 50% | Plan pays 50% |
|
Type D - Orthodontia (After Deductible): Adults and children
|
Not Covered | Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
Not Covered | $1,500 per person |
|
Annual Maximum (per person)
|
$1,000 per person | $5,000 per person |
Important Notes
-
No age limitations for coverage
-
$75 Employee deductible / $225 Family deductible (waived for preventive); differing annual maximums depending on plan
-
100% Preventive Coverage / 80% Basic Coverage / 50% Major Services / 50% Orthodontia (Premium Plan only)
-
Members utilizing Delta Dental participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
Claims Process
In-Network
- Participating Delta Dental providers file the claim and accept payment from Delta Dental
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network with Delta Dental, employee pays at the time of service and files a claim for reimbursement
- The plan reimburses at the 90th percent of Usual and Customary (U&C) for out-of-network providers. Charges by out-of-network providers that exceed U&C are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)
Teledentistry
Delta Dental offers two virtual dentistry options as part of their dental plan coverage. Below is a high level overview of the services.
- Toothpic is a non-urgent photo based teledentistry app. Toothpic helps to establish how serious a member’s concern is by providing a trusted dental consultation when it’s not practical to visit a dental office.
- Virtual Consult is an urgent video-based virtual appointment tool. It’s ideal for Delta Dental members who want to speak directly with a Delta Dental dentist and may have more oral care needs.
These tools are available to members on both plans. The visits are subject to coinsurance and would be charged similar to a dental exam. If both annual exams have not been utilized, there would be no cost. If both exams have been used for the year, you would have to pay for the service before the virtual exam begins.
