- If I currently have Delta Dental insurance with another state, and I live in Arizona, can I enroll for the Delta Dental of Arizona Individual Plan?
Yes. As long as you are an Arizona resident 18 years or older and are not eligible for Delta Dental of Arizona group coverage through your current employer, you can enroll in the Delta Dental of Arizona Individual Plan. back to top
- Are periodontal maintenance cleanings covered?
Yes, periodontal maintenance is interchangeable with the routine cleaning and is counted toward the benefit year limitation. back to top
- Can my dentist participate in Delta Dental's Premier network?
Yes. Just have your dentist call Delta Dental of Arizona and ask for "Professional Relations." It's easy, and there is no cost for your dentist to join. back to top
- Do I need to choose a participating Delta Dental Premier dentist?
You may visit any dentist, but you will have less out of pocket expense if you see one of Delta Dental's Premier Participating Dentists. back to top
- What is my benefit year?
Your benefit year is the 12 month period beginning on your effective date for the calculation of benefits, coinsurance, and deductibles. For example, if your effective date is February 1st, your benefit year will be from February 1st through January 31st of each year back to top
- Are sealants covered on all teeth?
Sealants are a benefit once in a three (3) years interval from the date last performed. Sealants are a benefit for the occlusal surface (free from decay or fillings) on permanent bicuspids, first and second molars. Sealants are benefits under age 15.
Occlusal: Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims. back to top
- Are space maintainers covered?
Space maintainers due to the premature loss of diseased posterior (towards the back of the mouth) primary (baby) teeth, up to age fourteen (14). Anterior (towards the front) space maintainers are not a covered benefit. back to top
- What kinds of fillings are covered?
A. Fillings consisting of silver amalgam and, in the case of front teeth, composite tooth color fillings are covered. Composite tooth colored fillings are not a benefit on posterior teeth, however an alternate benefit of an amalgam filling (silver) may be given. Fillings are a benefit once for each tooth surface in a twenty-four (24) month interval from the date this service was last performed on that specific tooth surface. back to top
- What kind of oral surgery procedures are covered?
Non-surgical and surgical extractions are included. back to top
- What is special restorative?
Special restorative includes the following services but does not provide for lost, misplaced or stolen appliances. Five (5) year waiting period for replacement last performed is applied to each.- Cast Crowns – Restoration covering or the major part or the whole areas of exposed teeth.
- Onlays - An indirect restoration made outside the oral cavity that overlays a cusp or cusps of the tooth, which is then attached to the tooth.
- Bridges – prosthetic replacement of one or more missing teeth cemented to the abutment teeth or implant abutments adjacent to the space.
- Partial denture - prosthetic replacement of one or more missing teeth that can be removed by the patient.
- Complete dentures – prosthetic device that replaces all teeth on a framework (upper or lower), that can be removed by the patient.
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- What is a waiting period?
A waiting period is the amount of time that must elapse between effective date and the day that you may receive a benefit. back to top
- Is the benefit year maximum an individual or a family maximum?
The maximum is for each person enrolled in the dental plan. back to top
- What is an oral exam?
The oral exam is an examination or evaluation of the oral cavity, also called the mouth, whose boundaries are the lips and teeth in the front and the soft palate in the rear. back to top
- Are braces covered or is there an option to purchase additional coverage?
Orthodontic coverage (braces) is not an available benefit. back to top
- Is there a pre-existing clause for missing teeth?
Your claim will not be denied solely because the tooth was missing prior to the effective date of coverage. However, waiting periods may apply and clinical criteria must be met. back to top
- Are cosmetic procedures covered such as bleaching?
Cosmetic procedures are not a covered benefit. back to top
- Can my dentist charge to adjust my dentures?
Yes, after the six months has elapsed since initial placement. Adjustments to complete or partial dentures are limited to two (2) adjustments per denture, in a twelve (12) months period. back to top
- Are services such as relines covered on dentures I received prior to having this plan?
Yes but waiting periods may apply. back to top
- Are periodontal maintenance cleanings covered?
Yes, periodontal maintenance is interchangeable with the routine cleaning and is counted toward the benefit year limitation. back to top
- Is difficult cleaning (debridement) covered?
Yes, one routine cleaning can be exchanged for a difficult cleaning. This benefit is allowed once every five years and is payable under Type 1 Preventive Services. back to top
- If I have coverage or am offered coverage through my employer can I purchase an individual plan?
If you are a current Delta Dental of Arizona member or are offered Delta Dental of Arizona by your employer, you are not eligible to enroll on an individual plan. However, if you are enrolled in any other dental plan, you are eligible to enroll and coordination of benefits will apply. back to top
- Is an exam separate from a cleaning?
Delta Dental of Arizona utilizes the American Dental Association (ADA) Current Dental Terminology code set to administer claims. The ADA separates these two different procedures into two different codes. back to top
- If my child needs nitrous (laughing gas) will it be covered?
General anesthesia and/or intravenous sedation/analgesia will not be covered for anxiety, behavioral or management problems. Benefits for general anesthesia and intravenous sedation/analgesia will be provided only if the following conditions are met. - Performed by a Dentist licensed to perform general anesthesia;
- Administered in a dental office;
- When performed in conjunction with surgical extractions.
- Necessary due to medically concurrent conditions, (i.e., neurological motor control problems) and documented by a medical physician;
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- Will my dependants need an ID card with their own name?
No. It is common practice to show only the subscriber’s name on the identification card and dental offices are familiar with this practice, and will be able to confirm dependant benefits with the subscribers information. back to top
- Will Delta Dental of Arizona be offering plans that do not have waiting periods?
No, not at this time. back to top
- Can I purchase upgrades to enhance my chosen plan?
Plan options are limited to the items outlined on the benefit summary. Upgrades to these plan designs are not available. back to top
- If I was covered as a dependent on a previous Delta Dental group plan for more than 12 consecutive months, and signed up for your Individual Plan within 60 days after the termination of my plan, would the waiting periods be waived?
Yes, whether you were the primary subscriber or a covered dependent, waiting periods may be waived as long as you apply within the 60 day required time frame, and have had 12 months of continuous Delta Dental group coverage. back to top
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