- The A&M Dental plan has a $1,500 per person maximum benefit each plan year and a $1,500 per person lifetime maximum on orthodontic care. When I have orthodontic care, do the expenses apply to both maximums or only the orthodontic maximum?
Those expenses will apply only to the orthodontic lifetime maximum.
- I am under the care of a periodontist and have my teeth cleaned twice a year and twice a year at my regular dentist’s office. Will the plan cover all of my cleanings?
The A&M Dental plan (PPO) covers the reasonable and customary cost of three cleanings per year whether the cleanings are done at a regular dentist's office or a periodontist's office. The DeltaCare USA Dental HMO plan covers the reasonable and customary cost of two cleanings per year, one every six months, whether the cleanings are done at a regular dentist’s office or a periodontist’s office. If you have your teeth cleaned more often, you must pay the cost of the additional cleanings.
- How do I find a Delta Network or Premier dentist in my area?
- Are there any pre-existing conditions that won’t be covered immediately under the DeltaCare USA Dental HMO?
No. All dental services will be covered under the DeltaCare USA Dental HMO as soon as your coverage becomes effective.
- If I enroll in DeltaCare USA, will my benefits be reduced if I go to a dentist who is not in the DeltaCare USA network?
DeltaCare USA will not pay benefits for treatment from a non-HMO dentist. You will pay the full cost.
- Why doesn’t DeltaCare USA have an office visit copayment of $30 like most of the health plans?
The DeltaCare USA plan allows you to pay a set fee (copayment) for each service. The fee varies according to the service, rather than being the same fee for all services, as with some health plans. For preventive care, you pay a copayment of $5 and the plan pays the rest.
Other copayments are higher.
- What’s the maximum benefit DeltaCare USA will pay in a year? Is it different for orthodontia?
DeltaCare USA does not have a maximum cost benefit for any type of treatment, including orthodontia. For each service you receive, you pay the copayment listed on the schedule, and DeltaCare USA pays the rest, no matter how many services you receive in a year.
- How do I find a DeltaCare USA dentist in my area?
To find a DeltaCare USA dentist, go to http://deltadentalins.com/tamus/
. You can also call DeltaCare USA at (800) 422-4234. However, because the A&M System is rural-based, network dentists are not available in all areas where we have employees and retirees.
- In DeltaCare USA, do I have to get all treatment from a single dentist?
You must choose a network general dentist, but you can change to another network general dentist up to four times a year by calling DeltaCare USA. Each covered family member can have a different dentist. You must get treatment from your network general dentist, unless your network general dentist refers you to a network specialist.
- Last year, my dentist recommended some treatment, and the A&M Dental plan said it would pay only for a less expensive treatment. Does DeltaCare USA have that same rule?
No. You and your network dentist agree on the treatment, and you pay the copayment for that treatment. DeltaCare USA will pay the remaining cost for whichever treatment you choose, even if a less expensive treatment is available.
- How is A&M Dental different from DeltaCare USA?
The plans have different benefits, provider networks and requirements. With A&M Dental, you can see any dentist you wish and receive benefits, and you can go directly to any dental specialists without a referral. Preventive care is covered at 100% of reasonable and customary fees (as determined by Delta). For other services, you pay an annual $75 deductible and then a percentage of the cost of what the dentist charges for the service. If you use a Delta Network or Premier dentist, you will likely pay less because Delta has contracted with these dentists to provide services at reduced prices. However, you do not have to use a PPO dentist to receive benefits. A&M Dental also has an annual benefit maximum of $1,500 per covered person and an additional $1,500 lifetime limit per covered person for orthodontic care.
With DeltaCare USA, you must use DeltaCare USA dentists to receive benefits, you must be referred by your general dentist to dental specialists and the specialist must be in the network. You pay a set fee for each dental service you receive.
- How can I find out exactly what my cost will be for my dental care under the A&M Dental plan?
One way to be sure you know what your cost will be is to ask your dentist what services he/she is recommending. You can then send your dentist's suggested treatment plan to Delta, and Delta will tell you what your share of the cost will be.