Answers to Frequently Asked Questions


How Can I Save with a Delta Dental Network Dentist?

How do I know if my dentist is a Delta Dental PPO or Premier dentist, and if not, how can a find a dentist who participates in either network?

What if I choose a dentist who doesn’t participate in the Delta Dental PPO or Delta Dental Premier network?

How do I get the most from my dental benefit plan?

How can I obtain claim and benefits information?

My dentist does not participate in a Delta Dental network. How can I nominate him/her for network membership?

How does the change to Delta Dental affect treatment in progress?

How does the change to DDIL affect orthodontic treatment in progress?

How does DDIL handle coordination of benefits (COB)?

When Do I Need a Predetermination of Benefits?

How Do I Submit a Claim?

Where Can I Find Oral Health Information?

How Can I Check Status of a Claim?

What is the Subscriber Connection?





Do I still have a Schedule of Benefits?
Yes, but you now have the benefit of Delta Dental of Illinois (DDIL) expansive dental networks. You can still go to any licensed general or specialty dentist, regardless of whether the dentist participates in one of our networks. In many cases, you can reduce your out-of-pocket expenses by using a Delta Dental PPO or Delta Dental Premier network dentist. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)
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How Can I Save with a Delta Dental Network Dentist?
When a dentist participates in a network, he/she agrees to accept an allowed amount as payment and cannot charge you the difference between his/her submitted amount and the allowed amount. With the State’s Schedule of Benefits, a non-network dentist can charge you for the difference between his/her submitted amount and the Schedule of Benefits amount.

Using a Delta Dental PPO or Delta Dental Premier dentist can result in savings for both enrollees and the State. In addition to out-of-pocket savings, you can maximize your benefit dollars – the lower the claim reimbursement, fewer dollars get applied to your annual plan year maximum.

The State of Illinois Group Dental Plans will have access to the following networks:

Dental PPO is a national preferred provider dental network. If you go to a Delta Dental PPO dentist, your out-of-pocket expenses often will be less because these dentists accept the lesser of their submitted amount or our reduced PPO amount as payment-in-full (less any deductible). If Delta Dental’s PPO allowed amount is lower than the Schedule of Benefits amount, Delta Dental PPO Dentists cannot balance bill you for the difference.
Delta Dental Premier is a national dental network that works with Delta Dental PPO to provide savings and protections for those who don’t use a Delta Dental PPO dentist. Delta Dental Premier dentists agree to accept the lesser of their submitted amount or Delta Dental‘s Premier maximum allowed amount as payment-in-full (less any deductible). If Delta Dental’s Premier maximum allowed amount is lower than the Schedule of Benefits amount, Delta Dental Premier Dentists cannot balance bill you for the difference.

Important Note: In some cases, the Delta Dental allowed amounts for Delta Dental PPO and Delta Dental Premier network dentists may be greater than the Schedule of Benefits amount, but less than the amount submitted by the dentist. In these instances, Delta Dental PPO and Delta Dental Premier dentists can only bill you the difference between the Schedule of Benefits amount and applicable Delta Dental’s allowed amount.

If you go to a non-network dentist, you can continue to receive benefits, but you may have to pay more because these dentists have not agreed to Delta Dental’s allowed amounts and these dentists can balance bill you for the difference between their submitted amount and the Schedule of Benefits amount.

Please see the following example that demonstrates how you can save with a Delta Dental network dentist. This is a hypothetical example only and assumes all deductibles have been met.

Delta Dental PPO Dentist Delta Dental Premier Dentist Non-Network Dentist
Dentist submitted amount $1,000 Dentist submitted amount $1,000 Dentist submitted amount $1,000
PPO allowed amount $600 Premier allowed amount $900 No negotiated amount $0
Schedule of Benefits amount $781 Schedule of Benefits amount $781 Schedule of Benefits amount $781
Your Out-of-Pocket Cost $0 Your Out-of-Pocket Cost $119 Your Out-of-Pocket Cost $219

When the Delta Dental Premier maximum allowed amount is greater than the Schedule of Benefits amount, but less than the dentist’s submitted amount, your out-of-pocket cost will still be less with a Delta Dental Premier dentist than with a non-network dentist.
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How do I know if my dentist is a Delta Dental PPO or Premier dentist, and if not, how can a find a dentist who participates in either network?
To find a network dentist, click here. You have access to Delta Dental PPO and Delta Dental Premier. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.) Click here for help finding a network dentist.

You can also call our Customer Service department, available 8:30 a.m. to 5:00 p.m. Monday through Friday, Central Standard Time or utilize the automated phone system, available 24 hours a day, seven days a week, at 800-323-1743 (press 5).
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What if I choose a dentist who doesn’t participate in the Delta Dental PPO or Delta Dental Premier network?
Our plan gives you the freedom to go any licensed dentist, but you may pay more if you go to a dentist who doesn’t participate in Delta Dental’s PPO or Delta Dental Premier network. Since the amount charged by non-network dentists are often higher than the DDIL allowed fees that network dentists accept as payment in full, your out-of-pocket expenses may be greater, and the State’s claim dollars may be higher. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)
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How do I get the most from my dental benefit plan?
Utilize a Delta Dental PPO or Delta Dental Premier dentist.
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How can I obtain claim and benefits information?
You can view eligibility, benefit, and claim information any time through the Subscriber Connection on our website. You must register for the Subscriber Connection. To register you will need the primary subscriber’s first and last name (it should be entered exactly as when you enrolled for coverage, for example, Richard rather than Rich), the primary subscriber’s member ID number (in most cases, the Social Security number) and the primary subscriber’s date of birth. You can also call our automated phone system at any time at 800-323-1743 (press 5) for information.

You can always speak with a DDIL customer service representative during normal business hours, 8:30 a.m. to 5:00 p.m. Monday through Friday, Central Standard Time.
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My dentist does not participate in a Delta Dental network. How can I nominate him/her for network membership?
You may nominate your dentist by completing the Dentist Referral Form. Or, call our customer service department and we will send him/her information on how to apply for membership. Dentists must meet our credentialing criteria to be accepted into our networks.
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How does the change to Delta Dental affect treatment in progress?
Payment for treatment-in-progress is based on the service completion date, regardless of the type treatment (except for orthodontia, which is prorated based on remaining treatment time).
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How does the change to DDIL affect orthodontic treatment in progress?
DDIL uses the same calculations we use for a new orthodontia case, prorating payment based on the remaining treatment time beginning with the effective date of the patient's coverage. However, if the treating orthodontist is not in the DDIL networks, payment will be made to the enrollee and not the non-network orthodontist. The initial treatment plan from the orthodontist is all DDIL needs, which should include the following: total case fee, total months of treatment and banding date. No claim forms are required on an ongoing basis. Our claims system automatically verifies eligibility, benefits, orthodontia status, etc. and issues monthly payments. There will be no adjustment to the coverage amount for orthodontic treatment in progress. The orthodontist who initiated treatment should continue providing services until the treatment is completed.
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How does DDIL handle coordination of benefits (COB)?
COB information is reviewed on a claim-by-claim basis. DDIL systematically screens electronic and paper claims as entered to identify if an enrollee has dual coverage. Claims that indicate the presence of other coverage or claims for families flagged with prior COB are subject to investigation. If the processing system already has the enrollee’s COB information loaded, the claim is automatically processed based on the plan’s COB rules (i.e., standard or non-duplication). If it is determined that DDIL is the secondary carrier, a code is entered in the appropriate family member’s files that causes future claims to process according to the plan’s COB rules.

When DDIL has been identified as the secondary carrier and a claim is received without primary carrier information, the claim is denied requesting the other carrier’s EOB. Payment will be issued upon receipt of this information.

The name and address of the other carrier is stored in notes attached to the enrollee’s record in our system. A flag indicating whether that coverage is primary or secondary is maintained separately for each enrollee. Back to Top

When Do I Need a Predetermination of Benefits?
It is not required, but we recommend that you ask your dentist to predetermine services over $200. If your dentist recommends a certain procedure that will cost over $200, ask him/her to determine what the amount will be in advance of performing the procedure so you have a clear understanding of what you will owe. This way, you and your dentist know up front how much will be covered under the benefit program and how much you will be required to pay for the service. A pre-determination of benefits is not a guarantee of benefits.
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How Do I Submit a Claim?
Network dentists automatically submit claims to us. If you use a non-network dentist, you may have to file your own claim form. You can find claim forms on our website.

Claims Mailing Address
P.O. Box 5402
Lisle IL 60532

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Where Can I Find Oral Health Information?
Your mouth matters. Visit our Mouth Matters website to find oral health resources and information to help you protect your smile for a lifetime. Back to Top

How Can I Check Status of a Claim?
You can call our automated phone system/IVR or log on to our Subscriber Connection to access claim information anytime, anywhere.
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What is the Subscriber Connection?
It’s an online resource that provides secure access to the following:

Claim status. You can check the status of a claim for you and your covered dependents.
Benefit information. You can find specific information about your benefits, such as program type, deductibles, benefit schedule information, coordination of benefits and age limitations, maximums used to date.
EOBs (Explanation of Benefits). You can sign up to receive electronic EOBs and access and print your and your covered dependents’ EOBs. Note: EOBs for services where members have no out of pocket expense are available via Subscriber Connection or contact customer service to request a copy.
ID cards. You can print a temporary ID card.

Please see the Subscriber Connection overview for more information.

*The Subscriber Connection requires registration. To register, Subscriber Connection. You will need to enter the primary subscriber’s first and last name, member ID number (in most cases, the primary subscriber’s Social Security number) and date of birth. Please note: the subscriber’s first and last name must match the group’s information. For example, Bob may be Robert, Lily may be Lillian, etc.
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Resources

Find a dentist near you
You have access to the Delta Dental PPO and Delta Dental Premier networks. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)
Click here for a guide to help you find a network dentist.


Use the Subscriber Connection to access claims status, retrieve benefit and eligibility information, print a temporary ID card and more. Click here for information about how to register for the Subscriber Connection.


Your Oral Health
Learn more about oral health topics and find ways to improve oral health.


Quality Care Dental Plan (QCDP)


Local Care Dental Plan (LCDP)


College Choice Dental Plan (CCDP)