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Delta Dental

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

Enrollment Change form Click on link and print form.  Return completed form to Human Resources.
Dental Claim form Send completed form to:

Delta Dental of Idaho
PO Box 2870
Boise, Idaho 83701

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

  1. 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.
     
  2. 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.
     
  3. 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.
     
  4. 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.
     
  5. 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.
     
  6. 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.
     
  7. 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.
     
  8. 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).
     
  9. 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).
     
  10. 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.
     
  11. 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.

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Dental Care Topics

bullet A Bite Out of History
bullet Cancer
bullet Dry Mouth and Snoring
bullet Emergencies
bullet Endodontics (Root Canals)
bullet High-Tech Dentistry
bullet Home Dental Care
bullet Oral Surgery
bullet Orthodontics
bullet Pregnancy and Children's Oral Health
bullet Prevention and Periodontal (Gum) Disease
bullet Prosthodontics
bullet Seniors
bullet Sores and Bumps
bullet Sports Dentistry
bullet TMJ
bullet Heart Disease and Oral Health
bullet Diabetes and Oral Health
bullet HIV/AIDS
bullet Cosmetic Dentistry

Dental Specialties

bullet 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).
 
bullet 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)
 
bullet 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.
 
bullet 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.
 
bullet 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.
 
bullet 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

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Dental Terms

Terms regarding oral health and wellness.

Glossary

A handy reference guide to common dental benefits and oral health terminology.

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