What is DeltaCare® USA?
DeltaCare USA is Delta Dental's prepaid plan that features set copayments, no annual deductibles and no maximums for covered benefits. Enrollees must select a primary care dentist in the DeltaCare USA network from whom they receive treatment as in a traditional HMO. With DeltaCare USA, businesses enjoy higher cost controls, while still providing employees with comprehensive dental benefits. DeltaCare USA delivers quality care for less cost than traditional fee-for-service plans. DeltaCare USA dentists undergo a comprehensive credentialing process to ensure they meet high-quality standards. Most diagnostic and basic restorative services are covered at little or no cost to the enrollee. Eligibility and Enrollment
Who is eligible for benefits?
Is there a maximum age for dependent children?
How do I enroll new employees or dependents?
How do I change the status of an employee?
Do employees have to enroll their dependents in the plan?
When are new employees eligible for benefits?
When does coverage begin for new hires or added dependents?
Termination
How do I terminate benefits for employees who leave the company?
What are the rules regarding group termination?
Can I terminate a member in the middle of the month?
Billing and Payments
When are payments for monthly invoices due?
Will coverage be affected if payments are made late?
Are there any penalties for late payment?
How does Delta Dental notify employers when payments are late or delinquent?
Can benefits be reinstated in cases of cancellation?
Miscellaneous Questions
Does DeltaCare USA support changes or upgrades to plans while a contract is in effect?
Can you accommodate Dual Plans?
Does DeltaCare USA offer orthodontia benefits?
Does DeltaCare USA insure employees who are located outside the United States?
Eligibility and Enrollment Who is eligible for benefits?
All full-time, permanent employees and their eligible dependents: spouse and dependent children. Law firms, associations, groups with seasonal employment, and groups without an employer/employee relationship are not eligible.
Is there a maximum age for dependent children?
Dependent children are eligible to the age of 19, or up to age 25 if a full-time student. Proof of enrollment in a college, university, or trade school must be submitted to maintain eligibility under the plan.
How do I enroll new employees or dependents?
Employers or benefit administrators can enroll new members in their plans using our online system on this web site, or by completing a DeltaCare USA Change/Enrollment form and submitting it to Allied Administrators. Existing dependents should be enrolled at the same time as the primary enrollee. New dependents can be enrolled the first of the month following qualification.
How do I change the status of an employee?
The following changes in status can be performed on this website, or by completing an Enrollment/Change form and submitting it to Allied Administrators:
- Enrollee Name
- Add dependent
- Delete dependent
Changes to mailing address or dental provider must be submitted directly to Delta Dental of California. For more information, please call (800) 422-4234. Also, social security numbers cannot be changed on this website. To correct an enrollee's social security number, please contact Allied Administrators. New enrollments or changes to existing enrollees may take up to five days to take effect.
Do employees have to enroll their dependents in the plan?
The answer to this question varies, depending on which option is chosen by their employer.
When are new employees eligible for benefits?
Current employees become eligible on the effective date of the dental program. New hires and their dependents are eligible on the first day of the month following date of hire. In addition, a business may customize its program to be the first day of the month following a specified number of months of continuous employment. However, employers must submit an Enrollment/Change form or enter the new employees on this website for coverage to commence.
When does coverage begin for new hires or added dependents?
Depending on when the information for a new employee or dependent is submitted, coverage will commence on the first day of the following month. Coverage begins as follows: Enrollment card must be received, or entered online: | To show a first of the month effective date by: | On or before the 15th of the current month | 1st of the following month | Example: | | If the information is received or entered online by June 14... | ...then coverage will begin on July 1 | | | After the 15th, but on or before the 25th | 15th of the following month | Example: | | If the information is received or entered online by June 22... | ...then coverage will begin on July 15th | | | After the 25th | 1st of the second month | Example: | | If the information is received or entered online by June 26... | ...then coverage will begin on August 1st |
Termination How do I terminate benefits for employees who leave the company?
You can terminate coverage for departing employees right on this website, or by submitting an Enrollment/Change form. If you need to terminate an employee's coverage after you've sent in his or her monthly premiums/enrollment, the change, which can be submitted online or through a completed Enrollment/Change form, must be received by Allied Administrators no later than the first of the month in which you'd like the termination to take effect. After the first of the month, termination will be made effective the first of the following month. What are the rules regarding group termination?
In order to terminate benefits for an entire group, 30 days written notification, prior to the actual date of termination is required.
Can I terminate a member in the middle of the month?
You can submit a termination at any time, but the effective date of termination from the plan will be the first day of the following month.
Billing and Payments When are payments for monthly invoices due?
Statements are mailed at the beginning of each month. Payments must be received by our bank on or before the 25th of the month. Please remember that your DeltaCare USA coverage is a prepaid benefit: your payment received on the 25th of the month pays for your coverage for the next month.
Will coverage be affected if payments are made late?
Yes. If payments are not received by the due date, your employees will not be shown as eligible for coverage until:
1. the dues are remitted, and
2. your group's files have been updated.
Please keep in mind that if your company's dues are delinquent, reporting of eligibility will be delayed. Because of this, assignment to a dentist and rendering of services will be delayed.
Are there any penalties for late payment?
Yes. If your company's premiums are not received by the due date, your account may be considered delinquent and a $20.00 late fee could be assessed. In addition, returned checks are subject to a $20.00 charge. If sufficient funds are not received immediately, coverage may be terminated.
How are employers notified when payments are late or delinquent?
If payment is not received by the 25th of the month, a late notice will be sent. If payment is not received by the fifth of the next month of coverage, termination notices will be sent on the next business day. This letter will notify you that your company's dental coverage will be terminated and enrollees will be unable to schedule appointments on or after the first day of the month, except for completion of treatment that began before that date. Please note that since this cancellation would be caused by your failure to pay the premium required to keep the plan in force, you will be responsible for notifying each enrollee of that cancellation.
Can benefits be reinstated in cases of cancellation?
No. In cases of cancellation there is a strict one-year waiting period before a group can be reinstated. Miscellaneous Questions
Does DeltaCare USA support changes or upgrades to plans while a contract is in effect?
We can accommodate plan changes and upgrades on a case-by-case basis, at the time of renewal. Any proposed changes to your plan must be requested in writing. Please contact your broker for more information.
Can you accommodate Dual Plans?
Yes we can, subject to certain regulations. Please contact Allied Administrators for details.
Does DeltaCare USA offer orthodontia benefits?
Yes. DeltaCare USA offers orthodontia benefits for children to age 19 or up to age 23 if a full-time student, as well as adults.
Does DeltaCare USA insure employees who are located outside of the United States?
No. |
