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General Information for Employers

Participating Dentists' Network
 

You'll get the best value from your program when you receive your dental care from one of Northeast Delta Dental's Participating Dentists:

No Balance Billing:  Because participating dentists accept their usual filed fees for service, you will normally pay less when you visit a participating dentist.

No claims processing:  Participating dentists will prepare and submit claims for you.

Direct payment:  Northeast Delta Dental pays the dentist directly, so you don't have to pay the covered amount up-front and wait for a reimbursement check.

To find out if your dentist is part of the Northeast Delta Dental network, call your dentist or visit our web site at www.nedelta.com. You can also call our Customer Service Department at 1-800-832-5700 or 603-223-1234.

Claim Process for Participating Dentists
 

Present your ID card to the dentist at the time of your visit.

The dentist will submit your claim to Northeast Delta Dental.

Northeast Delta Dental will send you a EOB (Explanation of Benefits) detailing what has been processed under your programs coverage. You are responsible to pay any remaining balance directly to the dentist.

 

Claim Submission Process for Non-Participating Dentists

If you visit a non-participating dentist, you may be requested to bring a claim form that is available by calling Northeast Delta Dental or can be downloaded from www.nedelta.com. Payment will be made to you, the Subscriber, unless the state in which the services are rendered requires that assignments of benefits be honored and Northeast Delta Dental receives written notice of an assignment on the claim form before payment for benefits is made. Payment for treatment performed by a non participating dentist will be limited to the lesser of the dentist’s actual submitted charge or Delta Dental’s allowance for non-participating dentists in the geographic area in which services are provided. It will be your responsibility to make full payment to the dentist. When there is not sufficient fee information available for a specific dental procedure, Northeast Delta Dental will determine an appropriate payment amount.

Predetermination of Benefits
 

Northeast Delta Dental strongly encourages predetermination of cases involving costly or extensive treatment plans. Although its not required, predetermination helps avoid any potential confusion regarding Delta Dental's payment and your financial obligation to the dentist.

Coordination of Benefits
 

When a covered individual under this program has additional group dental coverage, the COB (Coordination of Benefits) provision described in your Dental Plan Description booklet will determine the sequence and extent of payment. If you have any questions about COB, please contact our Customer Service department at 1-800-832-5700 or 603-223-1234.

Identification Card
 

Two identification cards from Delta Dental will be produced and distributed shortly after your enrollment. Both cards are issued in the subscriber's name, but can be used by everyone covered under the program.

Dental Plan Description Booklet
 

You will receive a Dental Plan Description booklet shortly after your enrollment. This booklet describes the benefits of your program and tells you how to use your plan. Please read it carefully to understand the benefits and provisions of your Northeast Delta Dental program.

Who is Eligible?
 

All eligible employees and their dependents, defined as:

Spouse;
Unmarried, dependent children to age 26;
Incapacitated dependent children, regardless of age.

If enrolling one eligible dependent, all eligible dependents must be enrolled unless they are covered elsewhere.

Guarantee Of Service ExcellenceSM Program
 

Northeast Delta Dental is committed to providing extraordinary service to all of its customers. We believe that when our people are inspired to pursue excellence in order to achieve a higher level of customer satisfaction, all of those who share in Northeast Delta Dental will benefit. To emphasize our commitment, we guarantee seven major areas of service to our clients and reinforce them by our comprehensive group refund policy.

Claims Inquiry
 

If you have further questions, please contact Northeast Delta Dentals Customer Service department at 1-800-832-5700 or 603-223-1234.

This information should be used only as a guideline for your dental benefits program. For detailed information on your group's terms, conditions, limitations, exclusions and guarantees, please refer to your Dental Plan Description booklet or consult your employer.