Delta Dental's Small Business Program
FAQs
Delta Dental PPO and PPO Plus Premier FAQ


 

Delta Dental PPOSM and PPO Plus Premier
Frequently Asked Questions


What is Delta Dental PPOSM?
Delta Dental's preferred provider organization (PPO) plan, provides access to the largest network of its kind nationwide.  Delta Dental PPO allows enrollees to visit any licensed dentist. However, enrollees receive their best benefits and usually have the lowest out-of-pocket costs when visiting a PPO dentist. PPO dentists are Delta Dental dentists who have agreed to charge PPO patients reduced fees. There are over 18,000 PPO dental offices in California (approximately 55% of the dental offices in California), making Delta Dental's PPO network one of the largest in California.

What is Delta Dental PPO Plus Premier?
With Delta Dental's unique PPO plan design feature, employers can take advantage of the savings from the PPO plan while providing employees with expanded access to Delta Dental dentists who can limit their out-of-pocket costs. Delta Dental PPO Plus Premier combines the PPO and Delta Dental Premier networks to maximize opportunities to save money. PPO dentists accept fees that are more deeply discounted than the fees accepted by dentists who participate in the larger Premier network. Employees who visit a non-PPO dentist may save more by visiting a Premier dentist than they can by visiting a non-Delta Dental dentist. PPO plus Premier provides maximum network access while offering deeper savings within the PPO network and additional cost protections with the Premier network.

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?
Can an employee who lost coverage under a spouse's plan enroll in Delta Dental's Small Business Program?
When are new employees eligible for benefits?
Does the Delta Dental Small Group Program support shorter eligibility waiting periods?

Termination
How do I terminate benefits for employees who leave the company?
What are the rules regarding group termination?
Can members be terminated or enrolled retroactively?
Can groups be terminated or enrolled retroactively?
Can I terminate a member in the middle of the month?
Are dental benefits covered under COBRA?

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 are employers notified when payments are late or delinquent?
Can benefits be reinstated in cases of cancellation?

Miscellaneous Questions
Does Delta Dental's Small Business Program support changes or upgrades to plans while a contract is in effect?
Can Delta Dental's Small Business Program accommodate Dual Plans?
Can employees be enrolled simultaneously in more than one dental plan with more than one carrier?
Does Delta Dental's Small Business Program offer orthodontia benefits?
Does Delta Dental's Small Business Program insure employees who are located outside the United States?
Does Delta Dental's Small Business Program support dummy social security numbers?



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:  legal 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?
Dependents are eligible to the age of 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 an Enrollment/Change Form and submitting it to Allied Administrators.

How do I change the status of an employee?
The following changes in status can be performed on this web site, or by completing an Enrollment/ Change Form and submitting it to Allied Administrators:
- Enrollee Name
- Add dependent
- Delete dependent
- Update address
Social security number changes cannot be performed through this website. They must be submitted in writing to Allied Administrators. New enrollments or changes to existing enrollees may take up to five days to take effect.

Can an employee who lost coverage under a spouse's plan enroll in Delta Dental's Small Business Program?
Yes. If an eligible employee loses dental coverage through his or her spouse, coverage by Delta Dental begins on the first day of the month following loss of coverage. To initiate coverage, you must submit proof of loss of coverage and follow the standard enrollment procedures. Loss of coverage can be shown by a termination letter (pink slip) from the spouse's employer, or a termination of dental benefits letter from the insurance carrier of the spouse's employer.

When are new employees eligible for benefits?
Eligibility begins following completion of a waiting period determined by the employer. New hires and their dependents are covered on the first day of the month following completion of the waiting period. New enrollments or changes to existing enrollees, submitted through this web site or through the standard Enrollment/Change Form and Enrollee Eligibility Statement, may take up to five days to take effect.

Does Delta Dental support shorter eligibility waiting periods?
Yes, Delta Dental does support shorter eligibility waiting periods, including date of hire. However, new members can only be enrolled on the first day of the month. Therefore, while the effective date of eligibility will be the date you request, you will be billed as if the new members were enrolled for the entire month.

 

Termination

How do I terminate benefits for employees who leave the company?
You can terminate coverage for departing employees right on this web site, or by submitting an Enrollment/Change form to Allied Administrators.

What are the rules regarding group termination?
Delta Dental requires 45 days written notification prior to the actual date of termination.

Can members be terminated or enrolled retroactively?
Retroactive terminations and enrollments are discouraged, but will be considered on a case-by-case basis.

Can groups be terminated or enrolled retroactively?
No.

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.

Are dental benefits covered under COBRA?
Yes, dental benefits are covered under the COBRA laws. Please consult our information on Administering COBRA for more details.

Billing and Payments

When are payments for monthly invoices due?
Statements are generated the first of each month and mailed the first week of the month, taking into consideration weekends and holidays. Payments must be received at our bank on or before the 25th of the month. Please remember that your Delta Dental coverage is a prepaid benefit: your payment received on the 25th of the month pays for your coverage for the coming 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 payments 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.

Are there any penalties for late payments or returned checks?
Yes. If your company's dues 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 current month of coverage, termination notices will be sent within the next 3-5 business days. This letter will notify you that your company's dental coverage will be terminated if dues are not received within 15 days. 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?
Yes, as long as there is no outstanding balance and the group has a good payment history.

Miscellaneous Questions

Does Delta Dental's Small Business Program 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 Delta Dental's Small Business Program accommodate dual plans?
Yes we can, subject to certain regulations. Please contact Allied Administrators for details.

Can employees be enrolled simultaneously in more than one dental plan with more than one carrier?
Yes. There are two scenarios:

Example A
Jeannie works for Bob's Tent Supply, a company who has a dental carrier. Jeannie's husband works for Standard Olive Oil, whose carrier is Delta Dental. Jeannie could be enrolled as a dependent of her husband on his Delta Dental plan, and as a primary member with her own employer's plan.

Example B
Andrea works for Walker Co., and is enrolled as a primary member in that company's Delta Dental plan. Andrea also works for PCG Corp., and also qualifies for benefits with that company's dental plan. Andrea can be enrolled with both carriers as a primary member.

Does Delta Dental's Small Business Program offer orthodontia benefits?
Yes, orthodontia is offered in some plans, and only for groups with a minimum of 10 employees.

Does Delta Dental's Small Business Program insure employees who are located outside the United States?
Yes, subject to the program rules. All claims are subject to prevailing currency exchange rates at the date of service.

Does Delta Dental's Small Business Program support dummy social security numbers?
No.