- Delta Dental PPOSM Provider – you receive the greatest value for your benefit dollar when you visit one of the dentists in this network.
- Delta Dental Premier® Provider – you have access to the largest choice of participating providers; however, your out-of-pocket costs may be higher than for the dentists in the PPO network for the same covered benefits.
- Out-of-Network Provider – you may choose to receive care from a dentist who does not participate in Delta Dental’s network; however, the cost may be higher than with a participating network provider since these dentists set their own fees for service.
Enrollment is limited to 60 days from date of hire, 60 days following a life-changing event, or during your Agency's annual or special open enrollment period. You will receive your policy and ID card from Delta Dental. Your dental card will only have the primary member’s name listed. Because benefits are payable annually, participants must commit to one full year of premium payments upon enrollment. Plan cancellation may only occur during annual Open Enrollment or due to a life-changing event.
Visit deltadentalins.com/GEBA and register online to:
- Print your dental card
- Track your claims
- View your personal benefits information
- Find a dentist in network
| Network | Crown Coverage | Accepted Fee | Delta Dental Payment* | Out-of-Pocket Cost |
|---|---|---|---|---|
| Delta Dental PPO Dentist | $1,200 | $700 | $350 | $350 |
| Delta Dental Premier Dentist | $1,200 | $850 | $350 | $500 |
| Out-of-Network Dentist | $1,200 | $1,200 | $350 | $850 |
| *PPO Pre-negotiated rate - This rate applies to all charges no matter the amount for procedure. | ||||
Once a GEBA member, always a GEBA member as long as you maintain a plan. That means you can keep your dental coverage as long as you desire regardless of retirement or resignation. If you decide to keep your coverage, please complete the Retirement/Resignation form. (You may need to select another form of payment.)
It is important to coordinate benefits in cases where both spouses have family dental coverage or have two plans that cover some dental work through their respective employers or outside sources. Delta Dental coordinates with the other insurance company to make sure that the combined payments on a claim do not exceed the total amount the dentist has agreed to accept from Delta Dental. The primary insurer pays benefits first and the secondary carrier pays next. Any amount not paid by the primary carrier may be paid in part or in whole by the secondary carrier. The dental plan of the person submitting the claim is the primary carrier. For dependents, the primary carrier is determined based on the “birthday rule.” The spouse whose birthday comes earliest in the year will have his or her dental plan designated as the primary carrier for purposes of covering their children. If you have dental insurance through your health care plan, it is always considered the primary insurer.
Delta Dental provides benefits for preexisting conditions as part of its focus on promoting good dental health. Delta Dental will take responsibility for any procedures beginning after the effective date of a participant’s coverage. However, some procedures, if started prior to enrolling in Delta Dental’s Plan, may be the responsibility of the previous carrier.
Click the link under “Locate a Participating Dentist". On the right side of the screen, select the network(s) you would like to search for. The Delta Dental PPO network is slightly smaller but offers the best coverage and rates. The Delta Dental Premier network is the nation’s largest network, but has slightly higher pricing and less coverage.
Participating dentists will normally file the claims for you. If for some reason this did not happen, download a dental claim form and submit it directly. You can also contact GEBA for help. We have a staff member who can assist with claims if you feel the plan did not properly cover your dental procedures. Contact GEBA at (800) 826-1126, Monday through Friday, 8am to 4:30pm.
While there may be a number of issues delaying the processing of a claim, these are the most common reasons:
- Coordination of Benefits exists when a person has more than one provider for Dental Insurance. With federal employees, this is common as many FEHB (Health plans) have a small Dental Insurance component. If this is the case, the Health Insurance Company is responsible to pay the claim initially. Once the first claim is paid, it is the dentists’ responsibility to submit a claim form and receipt of payment from the first insurance company to the succeeding insurance company. Most problems occur because the dentist does not send a completed package (claim and the receipt) to Delta Dental or they send these items separately and do not reference the other items. Contact GEBA if you need help resolving an issue like this: 800-826-1126.
- The member is not in Delta Dental’s system. From time to time, an enrollee is not entered in the Delta Dental system and this oversight is missed until a claim is filed. If this occurs, contact GEBA at 800-826-1126. We will ensure that your effective date is corrected and all eligible claims are processed.
Normally, your ID card arrives 2-3 weeks after your effective date as a new enrollee. If you need a card sooner, go to www.deltadentalins.com and register. Once registered, you will be able to print a copy of your Insurance Card. If it has been more than 3 weeks and you did not receive an insurance card, please contact GEBA at 800-826-1126.
All children, regardless of dependency or marital status, are eligible for coverage through age 26. Enrollment of these children is limited to the GEBA open enrollment period (this generally corresponds to the Federal Annual Benefits Fair Period) or a life change event. When your child is no longer an eligible dependent, they can become a Sponsored Family Member with their own plan.
For simple requests, the Evidence of Coverage (Standard Plan / Enhanced Plan) is the easiest way to determine coverage. This Evidence of Coverage refers to procedures using standardized dental codes. When pricing procedures yourself, it is in your best interest to request those dental codes from your dentist and match them to the Evidence of Coverage. A more time consuming, but in many cases a more accurate, way to determine coverage is to ask that your dentist request an Estimate from Delta Dental. As with all pricing, it is in your best interest to price procedures before having them done.
