Benefits: Insurance: Dental Coverage
Declining Dependent Dental
Dental Benefits
Filing Claims
Selecting a Dentist
Summary of Dental Benefits
Dental Benefits
The State offers the Delta Dental Premier Plan to benefit eligible employees and their family members. Participation in the plan is automatic for anyone enrolled in one of the State's medical plans. Note: Dental is available only if you participate in a State employee medical plan -- you can't elect dental coverage without electing medical insurance.
For details about the plan, including limitations, exclusions and waiting periods, see the plan contract.
Selecting a Dentist
With this plan, you can use any licensed dentist for covered expenses but it is to your advantage to use a participating Delta Dental dentist whenever you can.
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Delta Participating dentists have agreed to provide services to plan participants at a set schedule of negotiated fees. This means network participating dentists will accept plan benefits plus your share of costs (deductible and coinsurance) as payment in full.
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Non-Participating dentists are not limited in how much they may charge. For these dentists, the plan pays covered costs based on Delta's average fee. If a non-participating dentist happens to charge more than the average fee, you have to pay the extra in addition to any amounts you may owe for the deductible and coinsurance.
To find Participating Dental Providers, please contact Delta Dental Plan of Idaho, 1-888-333-3582 or go on-line http://www.deltadental.com/ Go to “Searching for a Dentist?” then select Delta Premier and follow the screen prompts.
Plan Features |
Benefit |
| Annual Deductible | $25 per person |
| Annual Maximum Benefit | $1,000 per person, not including orthodontic benefits |
| Diagnostic and Preventative Services - exams and cleanings (once every six months); x-rays | 70% of allowable charges |
| Basic Restorative Services (fillings and repairs) | 70% of allowable charges |
| Oral Surgery, Periodontics, Endodontics (root canals) | 50% of allowable charges |
| Major Restorative Services (crowns, dentures, bridges) | 50% of allowable charges (after 1 year waiting period) |
| Orthodontia-Limited to dependents 17 and under | 50% of allowable charges up to $1,000 lifetime maximum per child (after 1 year waiting period) |
Declining Dependent Dental
As an employee, if you elect medical coverage you're required to take dental. But you can decline dental coverage for your dependents anytime you wish. In order to decline dependent dental benefits, submit a State of Idaho Medical Enrollment Form, with "Self only" elected in the Dental Enrollment section.
Once you have declined dental coverage for your dependents, you may only add dependents back to your dental plan if the State holds a special dental open enrollment. Currently there is no annual dental plan open enrollment period.
Filing Claims
Soon after you complete initial enrollment, Delta Dental will send you a member identification card. When you use a participating dentist, your provider will use the information on your identification card to bill the plan directly and you won't have to make a claim.
If you use a non-participating dentist, you may have to make a claim for reimbursement. If so, submit a detailed invoice from your provider along with your name, employer's name, and subscriber identification number to:
Delta Dental
PO Box 2870
Boise, ID 83701