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Dental plans can be confusing. Below are the most common questions answered by our customer service representatives.
Visit our Members webpage, and sign in or create an account to print your ID card.
Or call us at 1-877-841-1478 during regular business hours to request a replacement ID card.
The annual maximum is the maximum amount each member is eligible to receive for certain covered services in a coverage year. Find more helpful explanations at our glossary page.
A deductible is the dollar amount you pay for covered services in a coverage year before benefits are available. The family deductible is reached from deductible amounts paid on behalf of any combination of members. Find more helpful explanations at our glossary page.
The frequency of cleanings each coverage year, and how much of the cost is covered, varies by plan. Many plans generally cover most or all of the cost of at least 2 general cleanings.
To learn more about your benefits, visit our Members webpage to sign in or create an account to check your benefits and eligibility or contact your company’s human resources department.
If your Delta Dental of South Dakota plan has orthodontic coverage, the group dental plan provides benefits for orthodontic treatment when it is rendered in a dental office by a licensed dentist/orthodontist throughout the full treatment until completed. The group plan does not include benefits for any self-administered or “do-it-yourself” orthodontics.
Yes. For services that your dental plan does not cover at 100%, having a pre-treatment estimate lets you know your out-of-pocket costs in advance.
For services costing $500 or more, your dentist should submit a Predetermination of Benefits of your proposed treatment plan to Delta Dental. We will process it and send your dentist an Explanation of Benefits that shows what would be covered and how much you would have to pay.
Keep in mind that although a pre-treatment estimate may state Delta Dental will pay a certain amount for a procedure, it is not a guarantee of payment, as circumstances may change (e.g.: your annual maximum could be met before the proposed treatment date).
Some procedures do have a limit to how often they can be covered by your plan. Most dentists are aware of procedure frequencies. This is another good reason to work with your dentist to get a pre-treatment estimate.
Yes. Visit our Individual & Family Plans page to find a plan that’s best for you.
You may be eligible for COBRA continuation coverage through your employer. There are various conditions that will determine COBRA eligibility. Contact your human resources department for more information. If you are eligible, your employer will provide COBRA information (including eligibility and length of continuance) to us.
If COBRA coverage is not available to you through your employer, we can help you with one of our individual/family plans. Visit our Individual & Family Plans page to find a plan that’s best for you.
Coverage depends on your plan. Generally, dependent children are covered to the age of 19, but their coverage could extend longer if they are unmarried AND they are a full time student. The dependent must be enrolled in an accredited college or university to be eligible for coverage. Remember, eligibility must be verified for each semester.
To learn more about your benefits, visit our Members page to sign in or create an account to check your benefits and eligibility or contact your company’s human resources department.
A participating dentist is as dentist that has signed an agreement with Delta Dental and agrees to certain guidelines, such as not charging Delta Dental members more than the pre-approved fees.
Participating dentists submit claims directly to us so you don’t have to.
Visit our Members page and use the Find A Dentist tool to find participating dentists in our networks. Around 98% of dentists in South Dakota are in our networks, so there’s a great chance your preferred dentist is included. You can also call your dentist to confirm whether he or she is a Delta Dental of South Dakota participating dentist.
You can go to any dentist you choose but you receive maximum out-of-pocket savings when you go to a Delta Dental participating dentist Around 98% of dentists in South Dakota are in our networks, so there’s a great chance your preferred dentist is included.
If the dentist you see is outside South Dakota, but participates with that state's Delta Dental company, benefits will be based on that state's approved fees. If the dentist doesn’t participate in that state’s Delta Dental company, benefits will be based on the state’s approved fees, which may be higher.
Participating dentists agree to accept payment based on the contract amount allowed or submitted amount, whichever is less. If the amount allowed for a particular covered service is lower than the dentist's submitted amount, he or she agrees not to charge the difference to the subscriber (charging the difference is called balance billing).
For example: Dr. Example charges $50.00 for a covered service. Delta Dental's contract payment amount is $40.00. When Dr. Example performs the service on a Delta Dental patient, his office files a claim. Delta Dental sends Dr. Example payment for $40.00, and the service is considered paid in full. By our contract agreement, Dr. Example may not "balance bill" the patient for the remaining $10.00.
Once we have processed your claim, you will receive an Explanation of Benefits (EOB) that describes the services your dentist submitted and the benefits that your plan provided.
Tooth colored (composite fillings) are considered to be cosmetic. Dental amalgam (silver fillings) are less expensive but equally effective treatment as composite fillings. Because of this, your plan reimburses your dentist for the least costly clinically equivalent fillings (amalgam) on back (posterior) molars.
We generally get information about changes in covered family members from your employer’s human resources department (unless you are covered by an individual/family plan).
Contact your human resources department for more information on the process and time limits for making such changes. If you are covered by an individual/family plan, give us a call during business hours at 877-841-1478.
It generally depends on who has financial responsibility for the children. If the parents have joint custody, then the parent with the birthday earliest in the calendar year has primary coverage.
If your former spouse has dental coverage that includes dependents, the children have coverage regardless of whether or not they reside with you or your spouse.
Having two dental plans (called "dual coverage") does not "double" your coverage. However, it may mean you will pay lower out-of-pocket costs. One plan will be considered primary (the one that usually covers you as an employee), and the other will be secondary (the one that typically covers you as a dependent).
If you have children covered, the primary plan is usually the plan that covers the parent whose birthday falls first in the calendar year (month and day, not year). For example, if your spouse's birthday is March 13 and your birthday is June 27, your spouse's plan is the primary plan for the children.
When a person has coverage through two carriers, benefits are coordinated by the two insurance companies so the person gets the maximum benefit from both plans, but not to exceed 100% of the total charge.
Claims should first be submitted to the primary plan for payment. If the charges are not paid in full by the primary plan, the claim should then be submitted to the secondary plan for possible additional payment on the charges.
Some dental plans may have a non-duplication of benefits rule. This means the secondary plan would pay only if the primary plan paid less than the secondary plan would have paid had it been the primary plan. In this case, the total benefit would be limited to the payment made by the primary plan, and you would be responsible for paying the remainder.
You do not need a referral from Delta Dental, but some specialists require referrals from a general dentist before providing treatment. You may also want to have the specialist submit a Predetermination of Benefits to determine any potential out-of-pocket costs. Exams and consultations by specialists may not be covered by your plan so check your benefits first to understand what you may pay out-of-pocket.
Delta Dental of South Dakota does not require special claims forms, and our participating dentists submit claims directly to us.
If your dental office is not a Delta Dental participating dentist and requires you to submit the claim form, visit our Members page to sign in or create an account to download a standard claim form. Your dental office will be able to help you complete the form and include information needed to process the claim.
Claims can be mailed to:
Delta Dental of South Dakota
PO Box 1157
Pierre, SD 57501