Our website allows you to view information about coverage for yourself and family members, including maximums and deductibles, benefit levels for standard and orthodontic coverage, and details such as the number of cleanings covered in a year. To review your summary of coverage, access our Online Benefits Lookup. Subscribers will need to register to access this information.
If you see a participating office, payment will be based on the Maximum Allowable Charge for a participating provider. If you see an out–of–network dentist, fees will be based on the plan allowance in that dentist's geographic location. The plan allowance is an amount that satisfies the majority of dentists' fees in a given geographic location. If the non-participating dentist’s charge is more than the plan will allow, the extra cost will be the responsibility of the subscriber.
Virtually all of Northeast Delta Dental plans cover resin (white) fillings on the teeth where their cosmetic advantages are most important: the six anterior (front) teeth. Resin fillings in posterior teeth (white fillings in back) are optional. If performed, the patient is responsible for any additional fee. We will pay an allowance equal to an amalgam restoration. For specific details on your plan's coverage of resin fillings, access our Online Benefits Lookup.
If you are out of the state/country and you experience a dental emergency, you may choose to have dental services provided by any licensed dentist. Many out–of–area dentists may request payment from you at the time of service. Reimbursement will be made to you directly based on the current rate of exchange. To help us process your claim in a timely manner, be sure to ask for a detailed billing statement that includes: treatment provided, tooth number, date of service, and total cost of service. If possible, have the billing statement translated into English. Attach the statement to a claim form and forward it to Northeast Delta Dental. You may download a claim form from the Online Benefits Lookup
Our networks are nationwide and most of our dental plans allow you to visit a dentist anywhere within the 50 states and Puerto Rico and receive the same benefits you would receive at home.
Many employer groups choose to add orthodontics to your dental plan as a benefit. Click here to access our Online Benefits Lookup to determine if orthodontics is included in your plan.
For a list of participating dentists, check our website under Find a Dentist. You will need to know if your group is Delta Dental Premier, Delta Dental PPO, or State of Maine Employees DPO. If you don't know your group's plan type, access the Online Benefits Lookup to find this information. After you have selected your group's plan type, you will answer a few questions about your location. Our system will then display a listing of dentists that you may print out.
A referral is not required for most Northeast Delta Dental plans . However, we encourage you to utilize the services of a participating dental specialist to maximize your benefit coverage. Payment of oral evaluations varies between dental plans. For example, if your plan pays for an oral evaluation once in a six–month period and you had one recently with your general dentist, an evaluation with a specialist may not be covered. Visit our Online Benefits Lookup to determine how evaluations will be paid under your plan.
New ID cards can be printed anytime from our Online Benefits Lookup site. You can also download the Delta Dental mobile app on your smartphone and have an e-ID card with you at all times.
The quickest way to receive a claim form is to visit our Online Benefits Lookup. You must log-in. If you have not used the service, you may click the registration link to register. You may also call our Customer Service department at 1-800–832–5700 Monday through Friday from 8:00 am to 4:45 pm (ET) to request a claim form. One will be either emailed to you as an attachment or sent to you by mail.
If you and your family are covered by more than one dental plan (or a medical plan that offers dental coverage), Northeast Delta Dental may coordinate benefits with the other insurance carrier. In determining coverage, total payments from both carriers cannot exceed the allowable charge for the service. If you have questions about Coordination of Benefits (COB), please contact our Customer Service department at 1-800–832–5700 Monday through Friday from 8:00 am to 4:45 pm (ET).
Dental benefits for cleanings vary between plans. Cleanings are paid out of the patient's benefit year maximum. To find out about your specific coverage, visit our Online Benefit Lookup.
Northeast Delta Dental will send the benefit payment directly to participating dentists. Our participating dentists agree not to charge at the time of treatment for covered services, but may request payment for non-covered services, deductibles, or co-payments. Northeast Delta Dental will send the benefit payment directly to you if you see a non-participating dentist. Payment may be requested in full at the time of your dental service.