Background on State of Illinois Legislation Regarding Assignment of Benefits to Non-Network Dentists for State of Illinois Group Dental Plan

According to state law, effective August 2012, State of Illinois Group Dental Plan members and their dependents can assign their dental benefits to non Delta Dental network dentists. The legislation states that if a dentist accepts assignment of benefits, he can only collect any deductibles, copayments or other charges that will not be reimbursed by the dental plan at the time of service.

For self-insured groups such as the State of Illinois Group Dental Plans, Delta Dental of Illinois usually does not assign benefits to dentists who do not participate in our networks. However, as a result of this legislation, State of Illinois Group Dental Plan members may now elect to have reimbursement sent directly to a non-network dentist

The member must consent to authorize payment of benefits directly to the non-network dentist and the non-network dentist must agree to not collect any payment from the member at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits.

If a member uses a non-network dentist and does not elect to assign benefits, payments issued by Delta Dental of Illinois will be sent directly to the member and the member will be responsible for paying the dentist up front, if requested by the non-network dentist, for treatment rendered.


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