|
Benefit Plan Summary
The Benefit Plan Summary is only a general summary of benefits
and does not constitute a contract or guarantee of payment. Full
terms and conditions are set forth in a contract between Kootenai
County and Delta Dental of Idaho which is on file with
Administrative Services.
DeltaDental.com Dentist Search
Delta Dental has a national network of dentist across the U.S.
and Puerto Rico. To locate a dentist, click on the above link, and
complete the required form fields.
Forms
About Delta Dental
Delta Dental of Idaho provides a wide range of innovative dental
plans for employer groups with 3 or more employees. Delta Dental
offers voluntary plans for groups with 10 or more employees.
Almost nine out of ten dentists in Idaho are members of the Idaho
Dental Premier network, making it the largest in the state.
Nationwide more than 114,000 dental offices are members of Delta
Dental\u2019s network.
Premier plans offer the most comprehensive benefit designs with
traditional fee-for-service dental benefit plans. All of our Premier
plans encourage preventive care. Member dentists agree to fee
increases and dental policy limitations, so there are no out-of
pocket surprises for employees and fewer problems for employers.
Delta Dental PPO plans offer employees and employers maximum
flexibility and value pricing.
Employees can choose any dentist, including dentists within the
Premier network, the PPO network or a dentist who is not in any
network.
Delta Dental is the only PPO plan in the state with access to both
the PPO and the Delta Premier networks. So even employees who choose
to go to a Delta Dental Premier provider are protected from paying
any charges beyond the dentists\u2019 Delta Premier fees.
Dentists in the PPO network agree to provide care based on a lower
fee schedule and employees who choose these dentists will receive
the highest level of benefits and the lowest out-of-pocket costs.
Employees will also receive the highest level of benefits when the
employee uses a specialist who participates in the Premier network,
even if the specialist is not a PPO participating dentist.
Frequently Asked Questions
- What is a Premier dentist?
Premier dentist has agreed that their charges will not exceed
the plan allowance. For a list of participating Premier
dentists,
click Dentist Search. A Premier dentist has also agreed to
submit any necessary claims to Delta Dental.
- What dentist can I see?
Most Premier plans give you the option of seeing any licensed
dentist; however, a nonparticipating dentist may charge more
than the plan allowances, and you will be responsible for any
charge above that amount.
- How can I find out what my remaining benefits are for this
current benefit year?
Contact Customer Service at (208) 489-3580 and we will review
your claims history to determine how much you have remaining.
- What do I do if I have a dental emergency and I'm out of
town?
Most of our plans allow you to see any licensed dentist. Refer
to your Benefit Book for any specific limitations.
- What does the term "least costly" mean?
If a tooth can be restored with a procedure that is less
expensive than the procedure rendered, benefits paid will be
based on the procedure that costs less.
- What is a Delta Dental "member dentist"?
A Delta Dental member dentist is a dentist who has signed an
agreement with Delta Dental stipulating that he or she will
provide dental treatment to subscribers covered by Delta
Dental's group dental care programs. Delta Dental member
dentists submit claims directly to Delta Dental for their
patients.
- What is an annual maximum deductible?
A Delta Dental member dentist is a dentist who has signed an
agreement with Delta Dental stipulating that he or she will
provide dental treatment to subscribers covered by Delta
Dental's group dental care programs. Delta Dental member
dentists submit claims directly to Delta Dental for their
patients.
- How long will it take to process my claim?
Over 90% of claims processed through our automated claims system
are paid in less than 15 business days if they are complete and
eligibility can be verified. You will receive an Explanation of
Benefits (EOB) notification that summarizes the services you
received, the amount we paid the participating provider and your
co-payment and/or deductible amount (if applicable).
- I received an Explanation of Benefits notification. What is
this?
An Explanation of Benefits (EOB) notification summarizes the
dental services you received. We mail an EOB to the subscriber
and participating provider. The EOB lists the claim number, a
description of services, the dentists' charge, Delta Dental
Plan's payment and the patient responsibility (co-payment and/or
deductible if applicable).
- I'm covered under two dental plans. How will you handle my
coverage?
If you and your family are covered by more than one dental plan
(or a medical plan that offers dental coverage), Delta Dental
will coordinate benefits with the other carrier. In determining
coverage, total payments from both carriers cannot exceed the
allowable charge for the service. If you have a question about
Coordination of Benefits (COB), please contact our Customer
Service department at (208) 489-3580.
- Who decides what the yearly maximum for services will be?
In most instances, the employer group, who is purchasing dental
benefits for their employees, is the decision-maker regarding
the benefits (co-pays, deductibles and maximums) to be offered
to their employees.
Return to Top
Dental Care Topics
Dental Specialties
 |
Endodontics
This is a dentist who treats problems that deal with the nerve of
the tooth. This specialist may perform simple to difficult root
canal treatments, or possibly a surgical root procedure, called an
apicoectomy (surgically removing the tip of the root) or a root
amputation (removing a root on a multi-rooted tooth).
|
|
|
Oral Surgery
This is a specialist who performs many aspects of surgery in and
about the head area, including:
- Simple extractions involving removal of soft tissue or
overlying bone or remaining roots
- Impacted teeth (especially wisdom teeth) involving removal
of soft tissue and/or overlying bone
- Soft tissue biopsies
- Removal of tumors in the oral cavity.
- Implant placement
- Complex jaw realignment surgeries (orthognathic surgery)
involving facial or bite discrepancies
- Jaw or facial fracture stabilization (repair of fractured
cheek or jaw bones)
- Repair of soft tissue problems (cleft palate or lip)
|
|
|
Orthodontics
This is a specialist whose goal is to straighten patient's teeth
through movement of the teeth through bone by the use of bands,
wires, elastics, headgears and other fixed or removable appliances
or retainers to achieve a balance between facial muscles and teeth.
This specialist treats children as well as adults who may desire to
improve their appearance and bite.
|
|
|
Prosthodontics
This is a specialist who deals with simple to complicated full-mouth
restorations or full-mouth rehabilitation; and may perform the
following procedures:
- Crowns
- Fixed bridges
- Partial dentures
- Full dentures
- Overdentures
- Implant reconstruction
- Full mouth reconstruction/occlusal rehabilitation
- Cosmetic dentistry
- Treatment of temporomandibular/orofacial pain disorders -
the patient may have pain associated with headache, neck,
shoulder, head, jaw, or other closely related area and/or
limited movements in any of these areas
Some prosthodontists have further training in maxillofacial prosthodontics
and treat patients who need prosthetic appliances, devices, or reconstruction
or replacement of facial deformities.
|
|
|
Pedodontics
This is a specialist whose focus is on the younger patient from
children as young as one or two to early adulthood. This dentist can
detect, treat, or refer, as needed, problems with decayed, missing,
crowded, or crooked teeth.
|
|
|
Periodontics
This is a specialist who deals with soft tissue of the mouth and the
supporting structures (bone) of the teeth. This dentist diagnoses
and treats gingivitis (inflammation of the gingival tissue) as well
as periodontitis (gingival tissue and bone disease). The following
procedures may be performed by this specialist:
- Simple and deep pocket cleanings
- Root planing
- Crown lengthening procedures
- Soft tissue and/or bone grafting
- Gingival or flap procedures
- Soft tissue recontouring or removal (gingivoplasty or gingivectomy)
- Hard tissue recontouring (osteoplasty)
- Implant placement
|
Return to Top
Dental Terms
Terms regarding oral health and wellness.
Glossary
A handy reference guide to common dental benefits and oral health
terminology.
|