Delta Dental Plan of Kansas, Inc. provides dental insurance to eligible employees of Crawford County.  Delta Dental Plan of Kansas, Inc. is a nonprofit dental service corporation incorporated under the laws of Kansas.

Make an appointment with a dentist.  The individual should tell the dentist they are covered by Delta Dental Plan of Kansas.  If the planned treatment involves any of the following, the dentist should submit a treatment plan to Delta Dental to determine how much of the bill will be paid by Delta Dental and what the individual’s share of the cost will be.

• Prosthetic and orthodontic procedures
• Individual crowns – except stainless steel
• Gold restoration
• Surgical periodontics
• Endodontics
• Oral surgery - except for simple extraction of a single tooth

Failure by the dentist to predetermine benefits may result in a higher cost to the individual than anticipated, if in the professional judgment of Delta Dental’s consultant, the treatment is not necessary or a lesser procedure could have restored the tooth to contour and function.

Even if the dentist does predetermine benefits, it does not obligate Delta Dental, if the individual is no longer eligible for benefits at the time the services are actually performed or the dentist was not a participating dentist with Delta Dental at the time services were performed.  The treatment must commence within 90 days of the date the treatment plan is submitted to Delta Dental by the treating dentist or a new treatment plan should be obtained and resubmitted.

Before treatment is started, the individual should discuss with the dentist the total amount of the bill and the portion, if any, the individual will be required to pay.  Under the Delta Dental Plan, individuals are free to go the dentist of their choice.  There may be a difference in the amount of payment, which will be made by Delta Dental if the dentist chosen is not a participating dentist with Delta Dental at the time services are performed.

For procedures performed by a participating dentist, payment will be made directly to the dentist on each covered procedure.  Any amounts withheld from payments by Delta Dental for reserves, research, or other purposes shall be deemed to have been paid as part of the claim of the dentist.  Individuals will receive notice of Delta Dental’s payment and of the amount, if any, that the individual owes to the dentist.  The amount owed should be paid in accordance with the dentist’s usual billing procedure.

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For procedures performed by a non-participating dentist, payment will be made to the employee on each covered procedure and will be based on the lesser of the actual fee charged or the average fee as determined from the filed fees of the participating dentist.

The maximum benefit payment for all covered dental procedures for each eligible person in any one contract year is $1200.  The maximum payment for orthodontic procedures for any eligible person is $1000 during that individual’s lifetime, which means Delta Dental will only pay $1000 of all orthodontic procedures for any individual for their entire lifetime.  Payment for the orthodontic procedures shall be included in determining the maximum benefit payment for each contract year.

Coverage for oral examinations, x-rays, prophylaxis, and sealants is not subject to any deductible amount.  For all other benefits covered, during each contract year, Delta Dental shall accrue no liability for any part of the first $25 of Usual, Customary, and Reasonable fee charged to or because of each eligible person for benefits provided to such person.  After the individual in any contract year has paid either the deductible amount of $25 or $75 for two or more people, the deductible shall no longer be applicable for any benefits during that contract year.

Emergency Treatment
Delta Dental’s group dental coverage includes services for emergency treatment.  Each individual dental office has its own emergency treatment procedure and patients should contact their dentist and familiarize themselves with the procedure for emergencies, which occur outside the dentist’s normal business hours.  Hospital or medical service emergency room expenses are not covered by benefits.

Frequently Asked Questions
Q:   I don’t have my ID card yet, but I have a dental appointment scheduled. What information does my dentist need? How can I get an ID card?

A:   Your dental office will need your social security number and your group coverage number. The dentist’s office may also call our office to verify coverage.

Q:   May I visit any dentist I wish for treatment? Is there a difference in benefits if my dentist doesn’t participate with Delta?

A:   Unless you are a member of an exclusive panel option plan, you are free to visit any dentist. However, you may have more out-of-pocket expenses, and will be responsible for any difference between Delta Dental’s payment and the non-network dentist’s fee, along with your copay. In addition, depending on your benefits plan, your coverage levels may be lower and there may be a bigger deductible if you go to a dentist who doesn’t participate with your plan.


Q:   What do you pay a non-participating dentist?

A:   We do not have advance access to the fees a non-participating dentist charges. If you wish to know your portion of your treatment costs, please ask your dentist to submit a predetermination of benefits to us. We will send you a copy of the summary that shows what Delta Dental will pay toward the treatment.


Q:   I already paid my dentist for the treatment he/she provided. Why won’t Delta Dental reimburse me directly?

A:   Dentists who participate with Delta Dental have agreed to accept payment from Delta Dental directly, so you should not be asked to pay for a covered service in full up-front. Delta Dental members who visit a participating dentist are only responsible for their deductibles, copayment amounts and non-covered services. If you feel you have been charged incorrectly, please contact our office.


Q:   I just received something in the mail from Delta Dental. It looks like a bill. What is it?

A:   You probably received an Explanation of Benefits (EOB) statement. This statement is not a bill; it explains what services your dentist provided and how Delta Dental processed and paid for the services.


Q:   I had a tooth pulled (extracted) and I had to file the insurance claim with my medical insurance. Why won’t my dental insurance pay the claim?

A:   Only claims for surgical extraction of wisdom teeth should be submitted first to your medical insurance carrier and then to your dental insurance. Some medical plans pay up to 100 percent of this procedure, so filing this type of extraction with your medical insurance could be of benefit to you. If there are any remaining charges after the medical insurance carrier has paid, your dental plan may cover the remainder or a portion of the remainder.


Q:   My child has braces and we just switched to Delta Dental. Will Delta Dental cover our orthodontic payments?

A:   Delta Dental will assume coverage of orthodontic benefits only if your employer’s previous dental carrier was making orthodontic payments at the time Delta Dental took over the group. It also must be specified in your group’s contract that it is takeover coverage. Standard processing policy is that if you are a new employee and had a dependent in orthodontic treatment prior to your employment with this company, Delta Dental will not cover your existing orthodontic payments.


Q:   Why does Delta Dental reimburse orthodontic payments monthly instead of paying the entire amount up front?

A:   Orthodontic payments are distributed throughout the period of time the services are rendered. This eliminates problems and confusion if the treatment is completed early, if the member’s coverage is terminated, if the group switches dental coverage to another carrier, or if the dependent reaches the age limit for orthodontic benefits or for dependent coverage, in general. Delta Dental’s policy is to pay only for completed services, so once the monthly visit is completed, a payment will follow.


Q:   Why did Delta Dental pay for a silver (amalgam) filling in my back tooth when my dentist filled the tooth with a white (composite) filling?

A:   Your plan only covers the cost of an amalgam filling in a posterior (back) tooth. If you and your dentist decide to restore the tooth with a composite resin, Delta Dental will allow for the cost of the amalgam, and you will be responsible for the remaining cost.


Q:   Why wasn’t my exam covered when my dentist referred me to a specialist?

A:   According to your contract, an examination is only covered within a certain period of time. This is true whether the examination is performed by a general dentist or by a specialist.


Q:   I had individual x-rays taken, but Delta Dental paid for a full mouth x-ray. Why?

A:   Delta Dental’s policy is that the fee for individual (periapical) or bitewing x-rays cannot be higher than the fee for a full-mouth x-ray series. If this occurs, Delta Dental will pay the amount for a full-mouth series.


Q:   Are predeterminations mandatory?

A:   Some groups and some conditions require predetermination of services before treatment is performed. Please refer to your certificate of coverage to see if predeterminations are required. Even if it is not required, Delta Dental encourages predeterminations for extensive treatments, or if you visit a non-participating dentist. There is no charge for a predetermination.


Q:   Does my group coverage run on a calendar year or a contract year?

A:   The anniversary date for coverage is decided by your employer group and by Delta Dental and varies from group to group. Check with your employer for specific information on your group benefits.


Q:   Why was my son/daughter taken off my dental policy?

A:   Under most group dental plans, dependents over age 19 are not eligible for dental coverage unless they are full-time students, earning at least 12 credit hours. If your child is eligible for student coverage, please notify your group so he/she can be reinstated on your policy.


Q:   What do I need to send in to verify my child’s full time student status?

A:   We need a copy of a document that would give us proof that the student is enrolled in at least 12 credit hours, (i.e., a copy of a paid tuition bill or a letter from the registrar).


Q:   Does Delta Dental offer individual policies?

A:   Delta Dental is a group dental benefits administrator; we do not sell individual dental plans.


Q:   Does Delta Dental have waiting periods for services?

A:   Delta Dental does not impose waiting periods, so Subscribers have immediate protection for all covered services. However, some employer groups have waiting periods. Please check your certificate of coverage to see if your group imposes waiting periods.


Q:   I’m covered under two dental plans. How will you handle my coverage?

A:   If you and your family are covered by both Delta Dental Plan of Kansas and either another Delta Plan or another dental carrier or medical plan that offers dental coverage, Delta Dental will coordinate benefits with the other benefits carrier. In determining coverage, total payments from both carriers cannot exceed 100 percent of the approved fee for the service. Please note that some groups have specified a “carve-out” clause in their dental programs that might limit a secondary carrier’s payment. If you have a question about Coordination of Benefits (COB), please contact our Customer Service department.


Q:   Do I need a referral to see a specialist?

A:   If you’re a member of DeltaPremier or DeltaPreferred Option (DPO), you do not need a referral to receive care from a specialist. However, we strongly encourage you to use the services of a participating specialist to maximize your benefit coverage.


Q:   I have a dependent who is fully disabled; how long can their coverage continue?

A:   As long as the individual is fully dependent on you for support, he or she can remain a dependent on your insurance policy. Written proof is required from the attending physician to verify the dependent's condition.


Q:   Can I add family members to my dental coverage at any time?

A:   Dependent family members can only be added during open enrollment periods through your employer, or when a qualifying event occurs. The following are considered qualifying events: Marriage/Divorce, Birth/Legal Custody/Adoption, Loss of Other Benefits Coverage, and Group Renewal Periods.


Q:   When does my coverage begin after there has been a qualifying event?

A:   Coverage begins the 1st of the month following the month in which the qualifying event occurs.


Q:   When do I become eligible for dental coverage with my employer?

A:   Waiting periods vary between groups. Check with your employer for information specific to your group.


Q:   How do I apply for COBRA coverage?

A:   You should contact your former employer regarding eligibility for COBRA coverage and to request an application for continuation of group dental coverage.


Q:   Do all employers have to offer COBRA coverage?

A:   Not all employers are obligated to offer COBRA coverage. Please check with your former employer for information on COBRA coverage. COBRA signup periods vary, so please also check with your former employer regarding time frames.


Q:   When does my COBRA coverage start?

A:   Normally, COBRA coverage begins the 1st day following your last day of coverage. However, please check with your former employer for specific information. Normally COBRA coverage is for an 18-month period, but it may vary depending on certain circumstances. Check with your employer for information regarding your individual situation.


Q:   I have not received a bill for my COBRA coverage, what do I do?

A:   Federal law does not require us to provide a monthly billing statement. As a courtesy we issue COBRA coupons to attach to your monthly payment, but it is the responsibility of the COBRA participant to make sure that their payment reaches us by the last day of the month for which premium is due. If payment is not received by the last day of the month for which premium is due, your COBRA coverage will be terminated and can not be reinstated. (Example: Premium for October coverage is due on Oct. 1, coverage will terminate if payment is not received by Oct. 31.)


Q:   How do I terminate my COBRA coverage?

A:   If you wish to terminate your COBRA coverage, please send written notification to our Eligibility department.

Contact Information
Dentists and eligible persons are encouraged to contact Delta Dental when they have a question concerning a particular claim.

For faster service, the following information should be available:

• Employee group number
• Social security number
• Patient name and birth date
• Dentist name and license number
• Claim number
• Date of service

Such inquiries should be directed to:

Customer Service Department

Delta Dental Plan of Kansas, Inc.

PO Box 49198

Wichita, KS 67201-9198

Telephone: toll free 1-800-234-3375 or (316) 264-4511

For any remaining questions, contact:

Joane Cook

Director of Payroll, Insurance, and Human Resources

Crawford County

PO Box 249

Girard, KS 66743

Telephone: 620.724.6117