Benefits administrator blog from Delta Dental

Category: Delta Dental plans and features (Page 1 of 4)

Learn more about the dental plans and features that Delta Dental offers.

Keeping dental insurance when budgets are tight

With today’s pandemic-related economic uncertainty and rising interest rates, you may find yourself with a benefits budget that’s stretched a bit thin. If you’ve considered dropping your group’s dental benefits to save money ― or don’t think you have the resources to add them ― we’ve got you covered.

DeltaCare® USA, Delta Dental’s DHMO-type product, offers comprehensive dental benefits for less than you might expect. These copay plans cover more than 400 procedures, so your employees won’t have to sacrifice quality care for affordability.

What it offers

Most DeltaCare USA plans include additional cleanings at reduced copayments, at-home teeth whitening, athletic mouthguards and porcelain crowns. And our orthodontic treatment in-progress provision allows new members to continue treatment with their current orthodontist, even if that orthodontist isn’t in our DeltaCare USA network.

Other advantages include: 

  • Tooth-colored fillings for any tooth
  • No lab fees or other hidden fees
  • No hidden charges for materials such as resins, metals or porcelain

What’s more, as a fixed copayment plan, DeltaCare USA offers your employees both convenience and simplicity:

  • No deductibles or maximums
  • No claim forms
  • Low or no copayments for diagnostic and preventive care

How it works

In most states, employees select a DeltaCare USA primary care dentist and pay their set copayment directly to the dentist. That’s it. Our primary care dentists even coordinate specialty care. An added bonus is that there’s no paperwork.

How it helps you

DeltaCare USA plans are easy to manage and offer predictable costs. Available resources include:

  • A comprehensive administrator support guide
  • A recently updated wellness library that includes a variety of helpful dental wellness content, including a risk assessment tool, wellness videos and dozens of articles

Remember, one of the biggest boosts to your budget is happy, healthy employees. Each year, over $45 billion is lost in productivity because of dental issues. When employees without coverage avoid going to the dentist or delay care, their dental issues often become more serious and may contribute to serious medical conditions, such as heart disease and diabetes.

So if you think budgetary woes mean dental coverage might not be in your future, consider DeltaCare USA. You’ll help your employees — and your budget — stay healthy.

Take the mystery out of dental expenses with the Cost Estimator

Your employees are busy enough, so trying to figure out how to budget their dental care shouldn’t become a second job. That’s why we created the Cost Estimator, a tool available for desktop and mobile that your employees can use to estimate quickly and easily what their next dental visit will cost.

What’s more, the Cost Estimator has just been refreshed with a new, accessible and mobile-optimized design.

How can the Cost Estimator can help my employees?

The Cost Estimator provides employees with a personalized estimate (based on the fee schedule from the last dentist from whom they received service) for an entire dental visit with a specific dentist. It calculates employees’ out-of-pocket costs based on their current benefits. Information is updated daily, so your employees can always count on getting an accurate cost estimate.

This versatile and easy-to-use tool offers employees a variety of useful features and information to help them make the most of their benefits and helps them become better informed consumers.

In the tool, employees can choose from a list of common dental procedures ― they can even specify which tooth needs treatment or what type of filling they’d prefer! After they select their procedure, the Cost Estimator calculates their estimated out-of-pocket cost. The tool subtracts both the network savings and the portion the plan pays.

Other tasks your employees can perform with the Cost Estimator include:

  • Adding procedures. If employees need to add services such as a cleaning or x‑rays to their visit, they can add them to their estimate to get the total cost of the visit.
  • Comparing dentists. Employees might be curious to see if they’d save by switching to another dentist. The Cost Estimator lets them compare up to five in-network dentists to find the best deal.
  • Selecting plan members. Employees can get cost estimates for anyone on their plan, such as spouses and children.
  • Reviewing benefits usage. Employees can access the benefits activity and history for everyone on their plan, and can also review their plan’s maximums, deductibles and out-of-pocket limits.

How can the Cost Estimator help my bottom line?

The Cost Estimator provides members with transparency about their out-of-pocket costs. More cost transparency can mean fewer questions and less confusion about the value of visiting an in-network dentist. By showing the substantial cost differences between in-network and out-of-network dentist visits, the tool encourages in-network utilization — which can help members save and may help lower your group’s dental plan costs.

Is the Cost Estimator available to my group?

Yes! All Delta Dental PPO™ and Delta Dental Premier® groups are eligible to sign up for the Cost Estimator. Talk to your Sales contact to find out how to add this service to your plan.

DeltaCare® USA members receive a plan booklet with their copayments for covered services, so this tool isn’t necessary for DeltaCare USA plans.

To access the Cost Estimator, employees simply click Plan ahead for a visit from the member portal. PPO and Premier members can also access a more limited version of the Cost Estimator through the Delta Dental mobile app, which features in- and out-of-network fees.


With the Cost Estimator, your employees can be confident not only about staying within their budgets, but also that they’re getting the best deal for themselves and their families. Be sure your employees don’t miss out on this valuable resource.

Get comprehensive utilization and health risk reports for your group

How do you know which dental benefits enrollees actually use and need? The true value of a dental benefit plan can depend on how much employees utilize their plan and which benefits they’re using. With Your Dental Health Summary, you can get these insights and more.

How are your employees using their dental benefits?

Your Dental Health Summary is a comprehensive report that helps you evaluate your enrolled employees’ utilization, oral health and risk status. The report highlights your group’s healthy behaviors and helps identify risk factors like the percentage of enrolled employees that had fillings, root canals or gum treatment. You can examine utilization and risk status indicators over time and compare your enrolled member population to benchmarks. Using this data, you can assess whether intervention, education or better patient habits could improve risk status.

What’s in the report?

When you open Your Dental Health Summary, you’ll see information about:

  • Your employees’ dental benefits utilization, including risk factors and healthy behaviors. See how your employees compare to benchmarks for taking advantage of diagnostic and preventive services. You can also review health indicators for employees at high risk for dental disease, with utilization patterns compared to benchmarks.
  • Your employees’ current oral health risk status compared to benchmarks. You’ll get risk categories for your entire group of enrolled employees, including new members, high-risk employees and employees with no dentist visits. You’ll also get a detailed breakdown of each category by age.
  • Your group’s oral health progress compared to previous years. Track the progress of your high-risk and low-risk employees and you’ll see whether your employees’ oral health has improved or declined and how many visited the dentist.

But what if you don’t know much about dental health? Your Dental Health Summary contains a guide to best practices for good oral health and how to support healthy habits. As you receive information about your employee’s plan usage, you’ll learn how to help high-risk employees and encourage dentist visits.

How do I get the report?

Your Dental Health Summary reports are available for groups with at least 500 primary enrollees. Because the reports track dental health trends over a period of several years, your group must have been effective with Delta Dental for at least two full years before you can receive your first report.

A report is generated each month but trends are tracked on an annual basis, so talk to your Sales Account Executive to discuss how often you’d like to receive the report. Reports are always delivered via email. Once you receive your report, Delta Dental’s team will also set up a meeting with you to walk you through the numbers, help you understand the data and answer any questions you have.


Making choices about your benefits package can be difficult when you don’t have a clear picture of how your employees are using it. With Your Dental Health Summary, you have a tool that gives you tailored and actionable information you can use to plan targeted, effective wellness initiatives for your group.

Twice as nice: dual coverage

Are your employees aware of dual coverage and how it works? If not, they could be missing out on substantial savings on their dental care.

Dual coverage (or coordination of benefits), as the name implies, is when a person is covered under two dental plans. This doesn’t mean double coverage, however. Both plans won’t fully cover each approved procedure. In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.

Why would my employees have dual coverage?

There are several scenarios in which an employee may have dual coverage:

  • An employee and his or her spouse both have employer-sponsored coverage
  • An employee has two benefits-eligible jobs

That’s good to know! How do my employees know which is their primary carrier?

Your employees and their dependent children may be eligible for dual coverage. Which insurance carrier is the primary depends on several factors.

For employees, the primary carrier depends on whether the employee also has dental coverage through a spouse or domestic partner:

  • If the employee does, the primary carrier is the one provided by his or her employer.
  • If the employee doesn’t, but currently has two jobs that provide dental coverage, the primary carrier comes from whichever employer has provided coverage for the longest time. If the employee has coverage through a current and former employer, the current employer’s plan is primary.

For dependent children, the primary carrier depends on whether the child’s parents are married and live together.

  • If they are (or have joint custody), the primary carrier is through the parent whose birthday falls earlier in the year. (If both parents have the same birthday, the primary carrier is the one that’s provided coverage for the longest time.)
  • If they aren’t and don’t have joint custody, the primary carrier is though the parent who has legal custody of the child.

Is there anything else my employees should know about dual coverage?

Yes. For starters, dual coverage applies only to group plans, not individual plans. Group plans can coordinate benefits only with another group plan.

If one of the plans covering the claim is an individual dental plan, that plan will always pay coverage as primary. Individual plans can’t coordinate benefits with other individual plans, either. In that situation, all plans will pay as primary.

Also, if employees have dual coverage, they must inform their dental office of both plans before they receive treatment. (Failure to do so could be considered insurance fraud!) Once they do, we’ll coordinate the cost sharing with the employee’s other plan.

An important caveat is whether the employee’s secondary policy has a non-duplication of benefits clause. While this clause won’t negate their dual coverage, it means the coverage will provide less benefit than standard dual coverage would.

For example, if an employee has dual coverage in which the primary carrier covers 50% of a procedure and the secondary carrier covers 80%, then 100% of the cost of the procedure would be covered. However, if the secondary carrier has a non-duplication clause, then only that carrier’s 80% would be covered.

Employees should also be aware that they’re still responsible for amounts that exceed maximums, charges above the allowed amount if using an out-of-network provider and charges for non-covered services.

Finally, dual coverage involving an HMO-type plan such as DeltaCare® USA can be complicated. Employees can contact Delta Dental Customer Service for details if they have dual coverage involving two HMO-type plans or a PPO and HMO-type plan.

Does Delta Dental have dual coverage resources for my employees?

We offer several resources to help your employees navigate their dual coverage. Your benefits resources page offers materials that explain dual coverage, how it works, who’s covered and offers helpful contact information for questions. Employees can also refer to the dual coverage information available on the Delta Dental member site.

Dual coverage at first may seem confusing, but with some guidance and our resources, your employees can enjoy maximum saving with minimum hassle.


Note: This post was updated to specify that dual coverage applies only to group plans and doesn’t apply to individual plans.

4 oral health problems teens face and how you can help

When you’re building your benefits package, are you thinking about teenagers? You may not have benefits-eligible teenage employees, but it’s likely your benefits package will be covering teenagers as dependents. Here are some common dental concerns that teenagers face and how you can develop a better benefits package to help your employees’ children.

1. Cavities

With teens’ love of snacking and their inconsistent brushing habits, it should be no surprise that dental decay is the most common chronic disease in young people. There are some easy ways to stop cavities before they start. Sealants are thin coatings painted on the chewing surfaces of teeth that can prevent cavities for years, which means that sealants applied during childhood can help during the teen years.

2. Misaligned teeth

Permanent teeth replace baby teeth in older children, and the jawbones can continue to grow until the end of puberty. A misalignment of the teeth and jaws may get better ― or worse ― by the time the jawbones have stopped growing.

Without coverage, prospective orthodontic patients can expect to pay between $3,000 and $6,000 depending on their age. Delta Dental plans can help cut these costs in half. Orthodontic coverage is available under all DeltaCare USA group plans and can be optionally included in any Delta Dental PPO plan.

3. Impacted wisdom teeth

Wisdom teeth are the last teeth to develop and erupt into the mouth, usually in the late teens. Since the jaw is still growing, wisdom teeth are sometimes impacted, meaning they don’t have enough room to emerge or develop normally. Almost 5 million people get wisdom teeth removed every year in the United States.

Wisdom teeth extraction can be expensive. Consider having your plan cover a higher percentage of the cost of wisdom teeth extractions. If that’s not viable for your plan, a lower deductible can help families as well by letting them pay less out of pocket before they reach their deductible.

4. Eating disorders

About 9% of Americans will develop an eating disorder at some point in their life, often in their teenage years. Eating disorders are life-threatening conditions that can have serious consequences for oral health and overall health. They can cause nutritional deficiencies that effect the mouth, as well as sensitive teeth, frequent cavities and dry mouth as a result of purging.

Dentists can be a great ally in the fight against the effects of eating disorders like bulimia (PDF) by identifying signs of the disorder, like eroded enamel and damaged gums, and offering sealants and fluoride treatments. These treatments can help reduce the damage that stomach acid causes when someone vomits. Most plans cover sealants and fluoride treatments until patients turn 15. If you’re also handling your clients’ health care package, you may also consider covering mental health treatment that can help to treat the illness altogether.

What else can you do to support teens’ dental health?

While these problems aren’t unique to adolescents, it’s still a good idea to have these in mind when considering your company’s dental benefits. If you’re in a position to do so, consider sharing information that highlights plan features like teledentistry, which could be helpful for busy teens and their parents. You could also explore Delta Dental’s wellness resources and share a selection of helpful articles and flyers in an email or on an internal site.

Remember to be consistent! When communicating helpful information to your employees, using multiple channels can be confusing and difficult to keep track of. Find a simple routine for sharing, like posting information on an internal webpage with monthly or quarterly email notifications, so that your employees always know where to look.

Sealants: A great value for your employees

Children’s Dental Health Month in February serves as an annual reminder of how crucial it is to start young people early on the right path for a lifetime of oral health. Your employees naturally want what’s best for their kids, so a simple benefit like sealants that help protect children’s teeth can be an important part of their insurance plans. Here’s a closer look at sealants and the types of coverage Delta Dental offers.

What are sealants?

Sealants are plastic coverings applied to the deep crevices of teeth to seal them off from decay. Think of them like raincoats for the teeth. Sealants are most often applied to permanent back teeth because they have the deepest grooves and are at the highest risk of decay.

How effective are sealants?

Sealants provide protection against tooth decay, preventing 80% of cavities for two years and continuing to protect against 50% of cavities for up to four years. Children without sealants have almost three times more first molar cavities than children with sealants.

Who needs sealants?

Children and teenagers ages six to 15 are the best candidates for sealants. Sealants can be especially beneficial for kids who have a history of cavities or are otherwise at high risk for dental problems (such as from secondhand smoke or from medications that cause dry mouth).

Why is sealant coverage an important benefit?

Sealants aren’t just effective; they’re also cost-effective. Sealants prevent tooth decay and can spare your employees’ families the hassle, discomfort and expense of cavities. And unlike treatment for cavities, sealant application is a simple, one-time, painless procedure. Access to sealants through dental coverage can provide your employees’ children with a health advantage they’ll value for a lifetime.

Delta Dental offers sealant coverage for groups and individuals

Most Delta Dental plans cover dental sealants, so your employees with covered family members can often get their kids’ protective sealants at little or no out-of-pocket cost. Sealants are a standard benefit in group Delta Dental PPO™ plans. Coverage for sealants can vary by policy. All standard DeltaCare® USA plans cover sealants.

Plans that include sealants generally limit the benefit to permanent first and second molars subject to age limitations by contract. Under some Delta Dental PPO plans, there is a maximum allowance payable per tooth, and the patient is responsible for the remainder of the allowed fee. Benefits for sealants include repair or replacement within 24 months by the same dentist or dental office.

If you haven’t already, consider offering sealants as a part of your employees’ coverage. If your plan covers sealants, educate employees about this valuable benefit. Share this flyer about sealants by email, or post it on your company’s website or intranet.

Sealants protect children’s oral health, and that’s a benefit parents will value. With Delta Dental, your employees can find affordable, highly rated coverage for the whole family.

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