Delta Dental of Illinois (DDIL) is pleased that we were awarded the dental services contract for the State of Illinois Group Dental Plans, effective July 1, 2011. We are committed to ensuring you and your covered dependents receive quality dental benefits and superior customer service.

You have the benefit of Delta Dental’s expansive dental networks. Dentists who participate in our networks undergo our credentialing processes and adhere to our processing policies. 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.)

How Does the Addition of Dental Networks Affect Your Dental Program?
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 your Schedule of Benefits, and as your plan has worked in the past, 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 maximize savings for enrollees and the State itself.

Delta Dental PPO is our 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 allowed PPO amount is lower than the Schedule of Benefits amount, Delta Dental PPO dentists cannot balance bill you for the difference.

Delta Dental Premier is our national dental network that works with Delta Dental PPO to provide network savings and protections for those not using a Delta Dental PPO network dentist. Delta Dental Premier dentists agree to accept the lesser of their submitted amount or Delta Dental’s maximum allowed amount as payment-in-full (less any deductible). If Delta Dental’s 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 dentist’s submitted amount. In these instances, Delta Dental PPO and Premier dentists can only bill you the difference between the Schedule of Benefits amount and Delta Dental’s allowed amount.

If you go to a non-network dentist, you will still receive benefits, but you may have to pay more because these dentists have not agreed to DDIL’s allowed amounts and these dentists can balance bill you for the difference between their submitted amount and the Schedule of Benefits amount. If you use a non-network dentist, you may have to pay the entire bill upfront at the time of service and/or file your own claim, depending on the arrangements you make with the dentist. Network dentists - Delta Dental PPO and Premier - have always been directly reimbursed by Delta Dental of Illinois. Now, you may also elect to have reimbursement sent directly to a non-network dentist, referred to as assignment of benefits, if the dentist accepts assignment. You must consent to authorize payment of benefits directly to a non-network dentist. If you do, the dentist cannot collect any payment from you at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits. You may have to file your own claim, depending on the payment arrangements you make with the dentist.

If you use a Delta Dental PPO or Delta Dental Premier network dentist, in addition to your out-of-pocket savings, you can maximize your benefit dollars – the lower the claim reimbursement, the less dollars applied to your annual maximum.

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 maximum 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.

How Can I Find a Delta Dental PPO or Premier Network Dentist?
you can find a network dentist online, just visit: http://www.deltadentalil.com/dentistsearch/. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)

How Will Claims Be Handled with Delta Dental of Illinois?
As is current practice with your plan, claim payments will continue to be released according to the claim process date and available funding.

If you use a Delta Dental PPO or Delta Dental Premier network dentist, you will not have to pay the dentist at the time of service (with the exception of applicable deductible, and amounts for services not covered). Network dentists automatically file claims for Delta Dental patients.

If you use a non-network dentist, you may have to file your own claim, depending on the arrangements you make with the dentist. Network dentists - Delta Dental PPO and Premier - have always been directly reimbursed by Delta Dental of Illinois. Now, you may elect to have reimbursement sent directly to a non-network dentist, referred to as assignment of benefits, if the dentist accepts assignment. You must consent to authorize payment of benefits directly to a non-network dentist. If you do, the dentist cannot collect any payment from you at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits.

How Can I Find More Information?
This website has a host of information. If you can't find what you need here, you can call our automated phone system at 800-323-1743, press 5. Customer service hours are 8:30 a.m. to 5 p.m. Monday – Friday Central Time.

As a reminder, you can log in to Member Connection to access claim information, benefit information and more.

If you have questions about your dental benefit program, contact the Central Management Services, Bureau of Benefits, Member Services at 1-800-442-1300. If you have questions* about a claim or a provider for services rendered July 1, 2011 and after, contact Delta Dental of Illinois at 800-323-1743, press 5 or email soiteam@deltadentalil.com Customer service hours are 8:30 a.m. to 5:00 p.m. Monday-Friday, Central Time. You can also use this number to access the automated phone system which allows you to find a network dentist or check claim status 24 hours a day.

*Issues regarding services, including claim payments, rendered prior to July 1, 2011, will continue to be handled by Humana CompBenefits at 800-999-1669.



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)