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Frequently Asked Questions


Does Delta Dental offer individual insurance?

Yes, Delta Dental of Missouri offers Delta Dental Individual and Family programs for Missouri residents and their families. Delta Dental Individual and Family members will receive comprehensive coverage, the freedom to select their own dentist, quality dental care and affordable rates. Click here for more information or to enroll in these plans.

 

Are predeterminations required?

No, they are not required, but they are suggested. A predetermination will let you know what out-of-pocket expenses you will have before the dentist's services are rendered.


How can I continue my dental coverage after I leave my job?

Check with your Human Resources Department to see if you are eligible for COBRA benefits. There are various conditions that will determine COBRA eligibility. Your employer gives COBRA information (including eligibility and length of continuance) to us.

Also, if you are a Missouri resident, you are eligible for one of Delta Dental’s Individual and Family plans. Click here for more information or to purchase a traditional individual plan directly from Delta Dental.


How can I find out if my dentist is participating, or get a list of dentists near me?

Visit our “Find a Dentist” page or contact our customer care team at 800-335-8266. Always verify the dentist’s participation with Delta Dental when making your appointment. Also, make sure your dentist is participating in the specific plan in which you are enrolled. With many of our plans, you can go to any licensed dentist, but your out-of-pocket costs will be lower if you choose a dentist who participates in the Delta Dental PPOSM or Delta Dental Premier® network. Dentists in our network agree to accept Delta Dental fees as payment-in-full for covered services, while dentists who do not participate with Delta Dental do not have an agreement with us and may charge more than our fees.


How do I know which program I am enrolled in?

Our “Find A Dentist” tool has an option just for this. Simply enter your social security number and your program name will appear. You can also find your plan information on your Delta Dental identification card.


Will Delta Dental pay dentists directly or will I receive payment?

If the dentist participates in either the Delta Dental PPOSM network or Delta Dental Premier® network, we will make payments directly to the dentist. If the dentist does not participate in one of our networks, then you will pay the dentist at the time of service and Delta Dental will reimburse you directly for the covered amount.


How are coordination of benefits (COB) determined?

The group contract and state regulations will determine how coordination of benefits will be applied. For the majority of cases, the birthday rule will apply. When a dependent child’s parents both have dental coverage, this rule states that the “primary” program (the one that pays first) is the one covering the parent whose month and date of birth falls first in the calendar year. Special guidelines may apply when the group contract supersedes the birthday rule. Ask your employer if their contract with Delta Dental has special COB guidelines.


What is my annual benefit maximum and how is it determined?

The annual benefit maximum is the dollar limit that is applied to benefit payments. Some programs have no maximums. Some maximums apply to the lifetime of the benefit program. Others apply to a particular period of time (calendar year, benefit year, etc.) or particular services (such as separate maximum for orthodontic benefits). You can determine your annual benefit maximum by logging in to your account, referring to your benefit booklet or contacting our customer care team at 800-335-8266.


What should I do if I move?

If you are part of an employer-sponsored plan, please give your new address to your Human Resources Department. If you have an individual policy, you may contact our customer care team at 800-335-8266 to update your information. You will also want to share your new address with your dentist.

 

Do I need a claim form? If so, how do I get one?

Most providers (those who participate with Delta Dental and those who do not) have claim forms in their offices and will submit the claim for you. If your dentist does not submit insurance claims, you can download a claim after logging in to your account. You will be required to enter a username and password to access this information.


What is required from me to establish full-time student status?

To verify full-time student status, you will be required to provide either your Human Resources Department or Delta Dental with a document showing that the dependent was enrolled in a minimum of 12 credit hours. The form of verification can be a report card, class registration or letter from the college or university. The dependent must be enrolled in an accredited college or university to be eligible for coverage. Remember, eligibility must be verified for each semester. Semesters run January 1 through August 31 (spring) and September 1 through December 31 (fall).

What is the correct mailing address for Delta Dental?

All paper claims should be mailed to P.O. Box 8690, St. Louis, MO 63126-0690.