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Coronavirus FAQ for Brokers

As a result of the recent COVID-19 pandemic, we are working to ensure our group clients and their employees or members are not adversely affected by this event in regard to their dental plan. Our first concern is the health, safety and well-being of those we work with and serve.

Below is a list of frequently asked questions and the responses for our brokers in regard to their client's dental plan.

What is Delta Dental of Illinois’ policy on furloughed employees?  Are they still eligible to be covered on our dental and/or vision plan?

Do furloughed employees need to move to a different location in the account structure? 

Is Delta Dental of Illinois offering “premium holidays” to clients impacted by Covid-19?  

Is Delta Dental of Illinois extending grace periods on monthly premiums?

Is Delta Dental of Illinois offering any reductions in monthly premium/fees for group clients?

Will there be an issue if in a month from now the majority of the insured employees are in a COBRA, and not active status? 

Is Delta Dental of Illinois allowing any kind of "special enrollment" to all employees to come on the plan?

Are employees who are below the minimum number of hours required eligible for benefits? 

Is Delta Dental of Illinois changing dental limits?

Does Delta Dental of Illinois intend to give participants an extension on the amount of time they have to submit a claim? 

How do members know what is a dental emergency?

How do DeltaCare DHMO members receive emergency care?

Please contact your Delta Dental of Illinois sales executive or account manager with questions specific to your group. We are here for you during these challenging times.

Responses to above questions:

What is Delta Dental of Illinois’ policy on furloughed employees?  Are they still eligible to be covered on our dental and/or vision plan?

The client group determines eligibility for members.  If they keep furloughed employees covered, but in a different location like COBRA, then coverage continues.  If they terminate the benefits for the employee, then they are termed, but Delta Dental of Illinois can waive a waiting period if the employee benefits are reinstated later.

Do furloughed employees need to move to a different location in the account structure?

This is ultimately the group’s decision since they send us the eligibility. We would normally expect furloughed or laid off employees to be in COBRA to meet not only our contract guidelines, but also those of  ERISA. However, with the current situation, we want to help facilitate client groups keeping benefits for their employees.  At this time, we will allow the group to choose the classification to keep their employees active or move them to COBRA. 

Is Delta Dental of Illinois offering “premium holidays” to clients impacted by Covid-19?

Delta Dental of Illinois is providing a 33% dental premium credit for all its fully insured clients for April 2020, which will be reflected on their July 2020 invoice. This credit applies to Delta Dental PPO Plus Premier plans only; DeltaCare is not included.  This credit will not impact any commissions you receive and your commissions will be paid in full. 

Is Delta Dental of Illinois extending grace periods on monthly premiums?

Delta Dental of Illinois is not extending grace periods for receipt of premium payments.

Is Delta Dental of Illinois offering any reductions in monthly premium/fees for group clients?

Delta Dental of Illinois is providing a 33% dental premium credit for all its fully insured clients for April 2020, which will be reflected on their July 2020 invoice. This credit applies to Delta Dental PPO Plus Premier plans only; DeltaCare is not included.  This credit will not impact any commissions you receive and your commissions will be paid in full. 

Additionally, we are holding our rates for groups with up to 500 enrolled employees for renewals from June 1 through August 1, 2020. 

Will there be an issue if in a month from now the majority of the insured employees are in a COBRA, and not active status?

There will be no issue;  we will administer the client the same whether employees are sent as active or COBRA.

Is Delta Dental of Illinois allowing any kind of "special enrollment" to all employees to come on the plan?

Yes. Enrollment additions, but not terminations, due to COVID-19 will be allowed as a qualified life event.

Are employees who are below the minimum number of hours required eligible for benefits? 

Yes. Eligibility is determined by the group, and as a result,  we can waive the 30 hour per week requirement for benefits for existing full-time employees.

Is Delta Dental of Illinois changing dental limits?

We don’t have plans to change any benefit limitations (e.g., annual max, deductible, frequency) at this time.  However, we do have some flexibility to modify eligibility if necessary. For example,  waive waiting periods for returning members.

Does Delta Dental of Illinois intend to give participants an extension on the amount of time they have to submit a claim? 

Providers and members have 15 months from treatment date to submit a claim. We are extremely hopeful that COVID-19 will not delay claim submittals past this standard 15-month filing time. However, If a member or provider needs an extension on a claim due to this national emergency, we will handle these on appeal as needed.

How do members know what is a dental emergency?

Delta Dental of Illinois has developed a flyer to help members determine if a dental issue requires immediate attention or can wait.

How do DeltaCare DHMO members receive emergency care?

DeltaCare DHMO members must select a primary dentist in the DeltaCare network and receive all services from that dentist. If specialty care is required, the primary dentist will refer the member to a specialist who is also a member of the DeltaCare network.  

In the case of emergency services, DeltaCare members are allowed one emergency visit per 12-month calendar year to a general dentist other than their selected primary DeltaCare dentist.

Emergency visits are for relief of pain only and any treatment needed related to the emergency condition must be completed by the selected DeltaCare primary dentist. For example, a root canal, crown or a tooth extraction are considered definitive treatment. Emergency treatment is a service such as a temporary filling, prescription or incision drain for the relief of pain, and would relate to palliative treatment ADA code 9110.

DeltaCare members will receive up to $50 reimbursement for emergency care. The payment that will be sent to the member directly upon receipt of a claim for the service rendered.  Anything over the $50.00 reimbursement is the member’s responsibility.

If the member elects to have full treatment performed by a dentist other than their selected primary DeltaCare dentist or a DeltaCare specialist referred by the DeltaCare primary dentist, the member will be responsible for the full treatment cost less the $50 emergency payment.