Does delta dental cover pre existing conditions

Q: Is a cavity a pre existing condition?

The term pre-existing condition” usually refers to major work rather than minor problems like cavities or deep fillings that eventually need to be crowned.

Table of Contents Show

What’s the minimum group size required for a quote?
What’s the minimum contribution level from the employer?
How many employees are required to quote orthodontics?
Are there any waiting periods for services?
Does Delta Dental have a pre-existing condition clause?
Explain Delta Dental’s position on Certificates of Portability.
Do members experience balance billing with Delta Dental?
What materials will the members receive after the program is implemented?
What are the commissions paid by Delta Dental?
Explain the methods of reporting eligibility.
Is a cavity a pre existing condition?
What dental procedures are covered by medical insurance?

What’s the minimum group size required for a quote?

The minimum group size for our plans is 10 employees. However, we also offer standardized plan options for small businesses with two to nine eligible/enrolled employees. Rates for these group segments are pooled for best overall savings.

What’s the minimum contribution level from the employer?

The minimum contribution level from the employer is 50 percent of the employee rate, unless you are selling a voluntary program.

How many employees are required to quote orthodontics?

We require a minimum of 25 employees before we will quote orthodontics, unless the group had orthodontic coverage through their previous carrier.

Are there any waiting periods for services?

No. Delta Dental does not have waiting periods for services, except for our voluntary plans.

Does Delta Dental have a pre-existing condition clause?

No. Delta Dental’s programs have no exclusions or limitations for pre-existing conditions.

Explain Delta Dental’s position on Certificates of Portability.

Dental is excluded unless the medical and dental are tied together. Since Delta Dental underwrites plans on a stand-alone basis, the aspects of HIPAA concerning certifications of creditable coverage do not apply. (Also, Certificates of Portability were created to address pre-existing condition clauses. Delta Dental does not underwrite plans with pre-existing condition clauses.)

Do members experience balance billing with Delta Dental?

No. Delta Dental members are responsible only for their copayments, deductibles and charges for noncovered services, if any, when they visit a participating Delta Dental dentist. Our participating dentists agree to accept our fee determination as full payment for covered services.

What materials will the members receive after the program is implemented?

Our standard materials include a program certificate booklet along with a summary of dental plan benefits describing the coverage levels. Additionally, the group will receive an administrative manual, eligibility enrollment forms, a dentist directory (if applicable), and a re-order form for materials.

What are the commissions paid by Delta Dental?

Delta Dental offers a flat percentage based on group size. Please see our contract or Agent Commission Schedule. Outside of this schedule, commissions can be determined on a group-specific basis, subject to rating adjustment.

Explain the methods of reporting eligibility.

Methods of reporting eligibility include online, tape, enrollment forms, diskettes and forms used by some other carriers.

Once you have completed and submitted your application, you will receive an “Enrollment Confirmation” email from . The email will contain a link so you can download your Coverage Document and ID card. To help ensure successful delivery of the email, please add “@morganwhite.com” to your safe senders list.

Who can enroll in this plan?

Individuals who are 18 years of age, and their eligible dependents (unmarried children from birth to age 26). Individuals 65 years of age and over are eligible to enroll, and will be charged the same rate as those enrollees under 65.

As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.

Delta Dental Insurance Company
P. O. Box 1809
Alpharetta, Georgia 30023-1809

Disclaimers and Disclosures:

Dental for Everyone Plans are underwritten by Delta Dental Insurance Company. Coverage under the plans is available only to Benefits Association Inc. (BAI) members. If you are not a member of BAI you must join to be eligible for Dental for Everyone Plans. Estimated premium includes the $1.00 per month membership dues for BAI and a monthly billing fee. Coverage under the plans is only available to BAI members in AL, CA, DC, DE, FL, GA, LA, MD, MS, MT, NV, NY, PA, TX, UT and WV.

This is a general group summary of the features of the Delta Dental Insurance Company plan issued to Benefits Association, Inc. When you purchase the plan you will receive a Certificate of Coverage that details your rights and obligations, as well as those of the insurance company.

This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.

Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.

This site was designed to provide you with a general description of the plans you requested. Keep in mind that it does not include all the benefits and limitations outlined in the policies -- it is the insurance contract, not the general descriptions on this website, which forms the contract between you and the insurance company.

DentalInsurance.com is paid by the Insurance Company we represent. We earn commissions for each policy we sell. The commission rates vary by Insurance Company and may increase based on sales volume. There may also be a bonus or incentive. For more information on a purchased plan or plan quoted to you, please reach out through our contact us page.

DentalInsurance.com Inc, its suppliers or any third parties named in this site are not liable for any damages that result from using, or inability to use, the website and material listed within it, whether based on warranty, contract, tort or any other legal theory and whether or not DentalInsurance.com Inc is advised of the possibility of such damages. This includes, but is not limited to, incidental and consequential damages, lost profits or damages resulting from lost data or business interruptions.

The use of the website and its material, some of it supplied by third parties, is at your own risk. Although we strive to provide the most current and complete information on this website, we make no representations about the accuracy, completeness or timeliness of the material found here. Please note that updates are made periodically to the website and we reserve the right to make them at any time.

Is a cavity a pre existing condition?

The term “pre-existing condition” usually refers to major work rather than minor problems like cavities or deep fillings that eventually need to be crowned.

What dental procedures are covered by medical insurance?

For instance, medically necessary tooth removal, the removal of impacted teeth, and the removal of teeth before radiation therapy or an organ transplant can be billed to medical insurance. However, in the case of preventive removal, the patient may need to obtain a referral from a physician.

delta dental cover pre existing conditions