Delta Dental Member FAQs

Find answers to frequently asked questions about Delta Dental of Illinois dental plans, dental coverage, dental networks and more.

Member FAQs

• What is the difference between Delta Dental PPO, Delta Dental Premier and Non-Network/Out-of-Network?

  Delta Dental PPO and Delta Dental Premier network dentists agree to accept our fees as payment in full for dental services. This means they cannot bill you the difference between what they charge for a dental service and what we allow. This requirement for network dentists is how we protect our members like you from unexpected charges.

  Cost savings are one reason to visit a Delta Dental network dentist, but there’s other advantages, too. Delta Dental network dentists must agree to abide by our processing policies and network contract. This includes a thorough credentialing process to join the network and ongoing re-credentialing processes to ensure dentists continue to meet certain standards.

  Delta Dental PPO is our PPO network. You will save the most and maximize your benefit dollars by choosing a Delta Dental PPO dentist. Delta Dental PPO dentists agree to our PPO fees, which are reduced from what a dentist would typically charge, as payment in full.

  Delta Dental Premier is a safety net to our Delta Dental PPO network. You will pay more out-of-pocket with a Delta Dental Premier dentist compared to a Delta Dental PPO dentist. However, you will save more money with a Delta Dental Premier dentist compared to a non-network dentist. Delta Dental Premier dentists agree to our maximum plan allowances, as payment in full.

  Non-network dentists do not agree to Delta Dental’s allowed fees and bill members for amounts over Delta Dental’s allowed amounts.

• How can I find out if my dentist is part of the Delta Dental network?

  Use Delta Dental of Illinois' dentist search to find a network. You can narrow your search based on the Delta Dental network a dentist participates in. You will save the most if you use a Delta Dental PPO network dentist. 

• Do I have to see a Delta Dental network dentist?

  DeltaCare members must select a DeltaCare facility and can only visit that dentist.

  Members who have Delta Dental PPO Plus Delta Dental Premier plans can visit any licensed dentist, but will save the most with Delta Dental network dentists.

  Delta Dental PPO and Delta Dental Premier dentists agree to accept our fees as payment in full for dental services. This means they cannot bill you the difference between what they charge for a dental service and what we allow. This requirement for network dentists is how we protect our members like you from unexpected charges.

  Cost savings are one reason to visit a Delta Dental network dentist, but there’s other advantages, too. Delta Dental network dentists must agree to abide by our processing policies and network contract. This includes a thorough credentialing process to join the network and ongoing re-credentialing processes to ensure dentists continue to meet certain standards.

• Where can I find my dental plan information and claims?

  Plan Information is available through our secure Member Connection. Sign in to access it or if you are not yet registered, sign up today.

• Who should I contact with questions about my dental coverage?

  Group members can log in to our member portal to access plan and claims information. You must register to login. Use this reference guide if you need assistance.

  Group members can also contact our Customer Service team at 800-323-1743 or email csi@deltadentalil.com.

  For answers to any questions you may have about Delta Dental of Illinois individual and family dental plans, you may call us at 844-764-5301.

  Visit our Contact Us page for further assistance.

• What should I do in a dental emergency?

  When you experience tooth pain or a tooth injury, it's important to seek dental care as soon as possible. Make sure you have your dentist's name and phone number with you as dental emergencies can happen at any time.

  See our tips for dental emergencies:

  • Delta Dental PPO Plus Premier plan members are free to visit any licensed dentist, but will save the most using a Delta Dental network dentist. 
  • Members using an ACA certified plan and wanting the ACA certified benefit must use a Delta Dental PPO dentist.
  • DeltaCare members must select a primary dentist who refers them to a specialist. In the case of an emergency, the DeltaCare procedures are below.
  • • If you are more than 35 miles from your primary dentist or are unable to see your primary dentist within 24 hours AND you require emergency treatment, you may go to any dentist and will be reimbursed for the treatment cost, less any applicable co-payment amount up to a maximum of $50 once during any 12-month period. Please note: emergency treatment and reimbursement for that treatment is intended for the relief of severe dental/oral pain, or to treat dental emergencies that risk life or disability without professional care. Follow-up care for treatment completion should be performed by your primary DeltaCare DHMO dentist.
    • If you are in this situation, you must contact customer service within 24 hours of treatment for authorization. You must also submit the dentist's statement and proof of payment for emergency services within 90 days after receiving treatment.
    • If a DeltaCare dentist is not available in the timeframes designated, please contact Delta Dental of Illinois Customer Service at 800-942-3772 and we will immediately investigate the specific reason for the unavailability.
• Do I need a pre-treatment estimate?

  Delta Dental of Illinois recommends that you get a pre-treatment estimate for any service over $300. If your dentist recommends a certain procedure that will cost over $300, ask them to determine what the fee will be in advance of performing the procedure so you have a clear understanding of what you may owe. Learn more here.

• Do I need a claim form?

  If you visit a Delta Dental of Illinois network dentist or assign benefits, you won’t have to submit any paperwork – your dentist will submit a claim directly to Delta Dental of Illinois on your behalf after your dental appointment.

  On the other hand, if you visit an out-of-network dentist, you may have to submit your own dental claim to Delta Dental of Illinois. Learn more here. 

• What is my annual out-of-pocket maximum?

  Most dental plans have an annual dollar maximum. This doesn't refer to a cap on the amount you will pay out of pocket. Instead, this is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within your annual benefit period.
  Once you reach your annual maximum, you are responsible for paying any costs for services above the maximum.

  However, if you use a network dentist for procedures covered under your plan, the dentist cannot charge you more than the allowed network amount.

• What's the difference between a deductible and a co-payment?

  A deductible is the total amount you have to pay before your dental benefits plan covers expenses.

  A co-payment is a set dollar amount you are required to pay your dentist for a service.

• If I'm covered under my employer's plan, can I continue my dental coverage if I leave my job?

  Check with your employer's Human Resources department to see if you are eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits. Your employer may share COBRA information (including your eligibility and length of continuance) with Delta Dental of Illinois to make sure you keep your coverage, if possible.

  Check with your employer and insurance provider to better understand your options, responsibilities, and next steps required to elect COBRA insurance. You may also visit benefits.gov to check your eligibility for COBRA.