Important Message for Illinois Dentists Regarding Collecting Payments Up Front from State of Illinois Dental Plan Members

At Delta Dental of Illinois, our mission is to improve the oral health of all Illinoisans. We know we can’t achieve this mission without the dedicated oral health professionals in our state. We also understand that the recent announcement by the State of Illinois regarding dental claims payments may cause significant challenges for State of Illinois Group Dental Plan members and the dentists who treat them.

In an effort to ensure all dentists are aware of our process in assigning benefits to network and non-network dentists (when requested by the member), we are issuing this update.

As a reminder, the State of Illinois is a self-funded plan and as such, Delta Dental of Illinois reimburses dentists once it receives funding from the State. Delta Dental of Illinois does not control the timing or funding of claims payments to State of Illinois dental members or the dentists who treat them.

You may have read an Illinois Department of Central Management Services (CMS) Bulletin dated September 9, which stated that

Please note: Illinois state law and Delta Dental of Illinois’ network dentist policy regarding assignment of benefits and amounts that can be collected upfront from State of Illinois Group Dental Plan members have not changed.

Delta Dental Network Dentists

In accordance with the Delta Dental network dentist agreement, State of Illinois Group Dental Plan members who receive services from Delta Dental network dentists cannot be charged upfront for any other amounts other than the following:

  • Applicable deductible,
  • Services not covered by the plan,
  • Amounts greater than the member’s Schedule of Benefits but up to the dentist’s contracted network amount.
  • Any amounts exceeding the annual benefit maximum.

Non-Network Dentists

In accordance with State of Illinois legislation, if a State of Illinois Group Dental Plan member receives services from a non-network dentist and elects assignment to that dentist, the dentist cannot charge the member upfront for any other amounts other than the following:

  • Applicable deductible,
  • Services not covered by the plan,
  • Amounts greater than the member's Schedule of Benefits but up to the dentist's contracted network amount.
  • Any amounts exceeding the annual benefit maximum.

If a State of Illinois Group Dental Plan 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.

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

Background on Delta Dental Network Policy

Background on State of Illinois Claims Payments



Resources

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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.


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