Frequently Asked Questions
Does Delta Dental offer individual insurance?
Yes, Delta Dental of South Carolina offers Delta Dental Individual and Family programs for South Carolina residents and their families. Delta Dental Individual and Family plan members will receive comprehensive coverage, the freedom to select their own dentist, convenient access to quality dental care and affordable rates. For more information or to enroll in these Individual plans.
How can I continue my dental coverage after I leave my job?
Check with your human resources department to see if you are eligible for COBRA benefits. Various conditions will determine COBRA eligibility. Your employer gives COBRA information (including eligibility and length of continuance) to us. Also, if you are a South Carolina resident, age 18 or older, you are eligible for Delta Dental Individual and Family plans, Delta Dental of South Carolina's new individual dental benefits product. With Delta Dental Individual and Family, members will receive comprehensive coverage, the freedom to select their own dentist, convenient access to quality dental care and affordable rates with no application or administration fees.
How do I know if my dentist accepts Delta Dental insurance?
Use our “Find A Dentist” tool or contact our customer service department at 800-335-8266. Always verify the dentist’s participation with Delta Dental when making your appointment.
How do I know which program I am enrolled in?
Our “Find A Dentist” tool has an option that will help identify your plan. All you have to do is enter your social security number or your Member ID and your program name will appear. Or you can ask your human resources department.
Will Delta Dental pay dentists directly or will I receive payment?
If the dentist participates in either the Delta Dental PPO™ network or Delta Dental Premier® network , we will make payments directly to the dentist. If the dentist does not participate in one of our networks, then you may be responsible for paying the entire bill at the time of service and Delta Dental will reimburse you directly for the covered amount. If the provider accepts Assignment of Benefits (AOB), then Delta Dental will reimburse the out-of-network provider for the covered amount and you will be responsible for the difference up to the provider’s billed fee.
How is coordination of benefits (COB) determined?
The group contract and state regulations will determine how coordination of benefits will be applied. For the majority of cases, the birthday rule will apply. When a dependent child’s parents both have dental coverage, this rule states that the “primary” program (the one that pays first) is the one covering the parent whose month and date of birth falls first in the calendar year. Special guidelines may apply when the group contract supersedes the birthday rule. Ask your employer if their contract with Delta Dental has special COB guidelines.
What is my maximum and how is it determined?
Your maximum is determined by your group contract. The maximum is a dollar limit that is applied to benefit payments. Some programs have no maximums. Some maximums apply to the lifetime of the benefit program; others apply to a particular period of time (calendar year, benefit year, etc.) or particular services, such as separate maximum for orthodontic benefits. You can determine your maximum by logging in to your account, referring to your benefit booklet or by contacting our customer care team at 800-335-8266. Our FAXBACK option will give you this information as well as benefit and deductible information.
What should I do if I move?
Give your new address to your human resources department and your dentist. Our records are changed by the information supplied to us by your employer or by the address we receive on the dental claim form.
Do I need a claim form? If so, how do I get one?
Most providers (participating and non-participating) have claim forms in their offices and will submit the claim for you. If your dentist does not submit insurance claims, you can download a claim after logging in to your account. You will be required to enter a username and password to access this information.
To what age are dependent children covered?
Usually to the age of 19, but could include children to age 23 if they are a full-time student. Please check your benefit booklet or contact your human resources department to determine age limits.
What is required from me to establish full-time student status?
To verify full-time student status, you will be required to supply either your human resource department or Delta Dental with a document showing the dependent was enrolled in a minimum of 12 credit hours. The form of verification can be a report card, class registration or letter from the college or university. The dependent must be enrolled in an accredited college or university to be eligible for coverage. Remember, eligibility must be verified for each semester. Semesters run January 1 through August 31 (Spring) and September 1 through December 31 (Fall).
What is the correct mailing address for Delta Dental?
All paper claims should be mailed to P.O. Box 8690, St. Louis, MO 63126-0690.
Does Delta Dental of South Carolina cover teledentistry?
Yes. Delta Dental of South Carolina covers teledentistry. Delta Dental – Virtual Visits, delivered by TeleDentistry.com, provides 24/7 access to a dentist, 365 days a year conveniently from home with the use of a smartphone, tablet computer with audio/visual capabilities. A teledentistry visit is counted as an oral examination under your plan. Learn More on Teledentistry.
When should members use Delta Dental – Virtual Visits?
Members should use Delta Dental – Virtual Visits when:
• they have a dental emergency and they do not have a dentist
• they need access to a dentist after hours and their dentist is not available
• they would like to consult with a dentist without leaving their home
How does Delta Dental – Virtual Visits work?
Members follow these four easy steps to access our teledentistry service:
• Step 1: Visit the Delta Dental - Virtual Visits patient portal
• Step 2: Fill out their e-documents
• Step 3: Take photos of the problem area
• Step 4: Connect with a TeleDentistry.com dentist and begin their consultation
TeleDentistry.com dentists provide initial consultation services and can write prescriptions when appropriate. Members will be referred to a Delta Dental network dentist for definitive diagnosis and treatment.
The TeleDentistry.com dentist will email consultation notes to members’ Delta Dental network dentist for further treatment. If they have not established care with a Delta Dental network dentist, with their authorization, TeleDentistry.com will refer them to an in-network dentist. Learn More on Teledentistry in-network dentist.
Is there a copay for a teledentistry visit?
A teledentistry visit is counted as an oral examination under your plan. The copay depends on the member’s dental plan.
How are teledentistry claims processed?
Teledentistry claims are processed under code D0140 – problem focused exam. A teledentistry visit is counted as an oral examination under the members’ plan.