Delta Dental Small Business Program
 

DeltaCare® USA Frequently Asked Questions


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?
When are new employees eligible for benefits?

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 payments or returned checks?
How does DeltaCare® notify employers when payments are late or delinquent?
Can benefits be reinstated in cases of cancellation?

Miscellaneous Questions
Does DeltaCare® support changes or upgrades to plans while a contract is in effect?
Can DeltaCare® accommodate Dual Plans?
Does DeltaCare® offer orthodontia benefits?
Does DeltaCare® insure employees who are located outside the United States?

Eligibility and Enrollment

Who is eligible for benefits?
All employees (primary enrollees) of the company purchasing benefits who work on a permanent, full-time basis as determined by the employer, are eligible for benefits, as are their dependents:  spouse or domestic partner (if offered by the employer) and dependent children to age 26.  Contractors (earnings reported on a 1099 form) are not eligible.  Dependents in military service are also not eligible.

Is there a maximum age for dependent children?
Dependent children are covered to age 26. Recently enacted federal legislation allows adult dependent children to remain on a parent's plan until the attainment of age 26, provided that the adult dependent does not have access to other employment-based health coverage. An older child who is disabled (i.e., unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment) may also be considered an eligible dependent.

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. Employees electing dependent coverage must enroll all their eligible dependents 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
- Update Address

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 enrollments may take up to five days to take effect. 

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 to receive benefits after completing any eligibility waiting period required by the employer. 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.

Termination

How do I terminate benefits for employees who leave the company?
You may terminate employees on this website, or by submitting an Enrollment/Change form. If you need to terminate an employee's coverage after you've sent in the employee's monthly premiums / enrollment, the change 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. The employer is responsible for notifying each enrollee of the cancellation. Retroactive terminations are not allowed.

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 issued at the beginning of each month. Premiums must be received by our bank on or before the 25th of the month. Your DeltaCare® USA coverage is a prepaid benefit and your payment received on the 25th of the month pays the coverage for the following month.

Will coverage be affected if payments are made late?
Yes. If premiums are not received by the due date, your enrollees will not be shown as eligible for coverage until the premiums are remitted, and your group's files have been updated. As a result, a dental office will not be able to confirm eligibility and treatment may be delayed.

Are there any penalties for late payments or returned checks?
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 may 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 in the next 3-5 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 prior to that date. In the event your dental plan is cancelled, you will be responsible for notifying each enrollee of the cancellation.

Can benefits be reinstated in cases of cancellation?
If it is determined that you may reinstate your plan after it has been cancelled, both delinquent and current premiums are due in full. It is important to note that premiums are due for the entire time enrollees remained covered under the plan, regardless of whether or not the plan is 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 DeltaCare® accommodate Dual Plans?
Yes, subject to certain regulations. Contact Allied Administrators for details.

Does DeltaCare® USA offer orthodontia benefits?
Yes. DeltaCare® USA offers orthodontia benefits for children to age 26, as well as adults.

Does DeltaCare® USA insure employees who are located outside of the United States?
No.