Health Plan Dental FAQs

  1. What is the advantage of using a network dentist versus a non-network dentist?

    You save money because dentists in the Delta Dental network have agreed to charge lower fees for services. If you use a Delta Dental PPO dentist, your diagnostic and preventive services are covered at 100% with no deductible. Network dentists file the claim forms for you. You are not required to pay the entire bill in advance. You may be required to pay your portion of the covered services at the time of initial service. The dentist will bill Delta for the balance.
  2. What if I use a dentist who is not a Delta dentist?

    You may be required to pay the entire bill in advance. You must file a claim form and submit it to Delta Dental. If your dentist's fees exceed the Plan's allowance, you are also responsible for the difference between the Plan's payment and the dentist's actual charges.
  3. How do I file a claim form?

    All dental claim forms, including claims for services performed outside the United States, should be sent to:

    Delta Dental Plan of California
    Claims Department
    P.O. Box 997330
    Sacramento, CA 95899-7330
    (888) 335-8227

    Claim forms may be ordered from the Plan Office by calling (800) 777-4013 or downloaded from the Plan's Web site: www.sagph.org.

    You can also order forms directly from Delta by calling (888) 335-8227 or you can download a claim form here. But remember, if you use a Delta network dentist there are no claim forms to file.

  4. How do I locate a Delta Dental PPO dentist?

    Contact your current dentist's office and ask them if the dentist is already a part of the Delta Dental PPO network; or call Delta Dental: (800) 427-3237 and follow the easy voice prompts; or check Delta's online directory via the Find Network Providers chart on this site. Be sure to select "Delta Dental PPO" under Plan.
  5. What is the difference between a Delta dentist and a Delta Dental PPO dentist?

    Three out of four dentists in the U.S. are Delta dentists. Delta dentists have an agreement with Delta, which means their fees are preapproved, they handle claims paperwork free of charge and they call Delta directly with any inquiries. Because Delta pays these dentists directly, you do not need to pay the entire bill and wait for reimbursement. Instead, you pay only the patient portion of the bill.

    Delta Dental PPO dentists are a select group of Delta dentists who, in addition to the above conveniences, also charge lower fees. And, when you visit a Delta Dental PPO dentist, you maximize your benefits. There are approximately 50,000 Delta Dental PPO dental offices around the U.S.

  6. Where can I obtain a list of dentists?

    You may request a list of Delta Dental PPO or Delta Premier dentists in your area by calling Delta Dental at (800) 427-3237. Please allow 7 to 10 business days for delivery.

    To obtain a list now or to check if your current dentist is a Delta Dental PPO or DeltaPremier (Delta) dentist, check the online dentist directory. This directory also offers mapping and routing information.

  7. Can I nominate my current dentist to become a Delta network dentist?

    Yes. You may nominate your dentist for Delta network membership by filling out a Dentist Nomination form. You may request a nomination form from Delta Dental.
  8. After I nominate my dentist for admission into the Delta Dental PPO network, how long does the process take? Can I use my dentist during the nomination process? Will my dentist automatically be admitted?

    The nomination process takes about 90 days. Not all dentists will choose to participate. Admittance is not automatic and until your dentist is accepted into the Delta network, he or she is considered an out-of-network dentist.
  9. Why are claims processed in California?

    All claims are processed in California for administrative efficiency; however, Delta Dental PPO is a nationwide network.
  10. Are dental implants a covered benefit?

    Effective 1/1/2008, dental implants are covered under the Major Services portion of the Plan's dental benefits (which are payable at 50%). Implants are subject to the current prosthodontic limit of one implant every five years, as well as the Plan's annual maximums and deductibles. Any additional surgical procedure or special imaging performed in connection with the placement of the implant is not covered under the dental or medical plan. The Health Plan strongly suggests that you ask your dentist to request a pre-treatment estimate from Delta Dental, so you know upfront what the Plan will pay and the amount you will be responsible for.
  11. How many oral exams and cleanings does the Plan allow?

    The Plan allows one oral examination every six months and two cleanings per calendar year. When services are provided by a Delta Dental PPO dentist, there is no deductible and 100% of the dentist's fee is covered. To help avoid an increased risk of periodontal complications due to hormonal changes, effective 1/1/2008, the Health Plan added an additional oral exam and cleaning for women while they are pregnant. To take advantage of this added benefit, the dentist will need to note on the claim that the patient is pregnant. Individuals receiving post-periodontal surgery maintenance from a network dentist are eligible for cleanings and scalings up to four times per year.