Small Group Dental Solutions...Minor restorative services, periodontal maintenance, simple...

Small Group Dental Solutions 2-9 Enrolled Employees

North Carolina2019 Effective Dates

One-year contract

1 8/2018

Plan Selected

Non-EHB Benefits

Delta Dental PPO

Delta Dental

Premier / Nonpar

Covered ServicesDelta

Dental PPO

Delta Dental

Premier / Nonpar


Dental PPO

Delta Dental

Premier / Nonpar


Dental PPO

Delta Dental

Premier / Nonpar

Covered Services

Diagnostic & Preventive Services

100% 80%

Exams, cleanings, fluoride, space maintainers,

emergency palliative treatment, brush biopsy,

and sealants

80% 80%


emergency palliative treatment, brush biopsy, sealants, and radiographs

100% 80%


emergency palliative treatment, brush biopsy,

and sealants

50% 50%


emergency palliative treatment, brush biopsy, sealants, and radiographs

Basic Services 80% 60%

Radiographs, minor restorative services,

periodontal maintenance, simple extractions, relines

and repairs

60% 60%Minor restorative services, periodontal maintenance,

relines and repairs80% 60%

Radiographs, minor restorative services,

periodontal maintenance, simple extractions, relines

and repairs

50% 50%

Minor restorative services, periodontal maintenance, simple extractions, relines

and repairs

Major Services 50% 50%

Endodontics, periodontics, other oral surgery, other

basic services, major restorative services, prosthodontics, and

implants

40% 40%

Endodontics, periodontics, oral surgery, other basic

services, major restorative services, prosthodontics,

and implants

0% 0%



implants

50% 50%



implants

Maximum (per person, per calendar year)

Deductible (per person/per family, per calendar year)

Waiting Period

EHB Plan Required**

Area 1 Counties: Alamance, Cabarrus, Cumberland, Durham, Forsyth, Guilford, Mecklenburg, Orange, Union, Wake

High-RiskOccupation

High-RiskOccupation

High-RiskOccupation

High-RiskOccupation

Single $39.12 $34.24 $25.50 $26.63Two Party $76.47 $67.65 $52.66 $54.20Family $131.51 $120.32 $106.62 $109.36

Area 2 Counties: All other counties not in Area 1

High-RiskOccupation

High-RiskOccupation

High-RiskOccupation

High-RiskOccupation

Single $34.12 $30.39 $22.26 $23.59Two Party $66.38 $59.63 $45.62 $47.53Family $114.51 $103.76 $80.68 $84.63Rates do not include any applicable claims taxes.Rates are for both Non-EHB plans and plans that require EHB benefits for members under age 19.

**Certified EHB plan information is on the next page.

Certified EHB Low Plan - Delta Dental PPO plus Premier




NC - Plan AA #7779Delta Dental PPO plus Premier

NC - Plan B #7776Delta Dental PPO plus Premier

NC - Plan C #7777Delta Dental PPO plus Premier

NC - Plan D #7778Delta Dental PPO plus Premier

$1,000 $1,000 $1,000 $1,000

$50/$150Applies to basic and major services

$75/UnlimitedApplies to basic and major services

$75/UnlimitedApplies to basic and major services

$75/UnlimitedApplies to all services

12 Months*Applies to major services None None 12 Months*

Applies to major services

Standard Occupation

Standard Occupation

$35.10 $30.84

$30.61 $27.38 $20.04 $21.23

$108.14 $96.38 $75.13 $78.67

Participation Requirements:Number Eligible: 2 3 4 5 6 7 8 9 10+Minimum Insured: 2 3 3 4 4 4 5 5 50%

NOTE: Immediate family members must be enrolled on one application and count as one eligible member. At least 75 percent of the employees must be physically located in the state where the

contract is held.

Industries Not Eligible (the following industry groups are not eligible for coverage, however they may be eligible for coverage through our individual product offerings. Contact your Delta Dental sales representative for more information): * 1099 Contractors *Beauty/barber shops * Leased employees * Private households * Seasonal work (farming and agricultural labor)

Standard Occupation

Standard Occupation

$59.55 $53.72 $41.10 $42.83

Standard Occupation

Standard Occupation

Standard Occupation

Standard Occupation

$22.97 $23.99

*The waiting period can be waived for employees previously enrolled in an equivalent dental plan for the 12 months prior to the client's initial effective date. Proof of prior dental coverage is required with the new Client Information Form for clients who wish to have the waiting periods waived.

High Risk Occupations: * Amusement/entertainment groups (amusement parks, casinos, movie theater, pool halls) * Auto sales and service (new and used auto sales, car washes, repair shops) * Bars/taverns * Gas stations * Health/sport/country clubs * Hotels/motels * Insurance agencies * Janitorial services * Laundry/dry cleaning * Liquor stores * Parking lot facilities * Pawn shops/used merchandise stores * Professional offices (doctors, lawyers, architects) * Real estate agencies * Religious organizations * Restaurants * Security guard services * Studios (dance, theatrical groups, photography)

$68.62 $60.95 $47.44 $48.83$120.58 $108.39 $96.06 $98.52

Small Group Dental Solutions 2-9 Enrolled Employees

North Carolina2019 Effective Dates

One-year contract

2 8/2018

Certified EHB Benefits (for members under the age of 19)

Delta Dental PPO

Delta Dental Premier / Nonpar Covered Services

Diagnostic & Preventive Services

90% 80%

Exams, cleanings, fluoride, space

maintainers, radiographs, and sealants

Emergency Palliative

100% 100% Emergency Palliative

Basic Services 50% 50%

Minor restorative services, endodontics,

periodontics, oral surgery, other basic services, relines and

repairs

Major Services 50% 50%Major restorative

services, prosthodontics, and implants

Orthodontic Services

50% 50% Medically necessary orthodontics

Maximum (per person, per calendar year)

Deductible (per person/per family, per calendar year)

Waiting Period

EHB Note: If EHB is selected, any non-EHB covered services that are not covered in the pediatric plan will be covered for people under age 19, subject to the non-EHB limitations and maximum payment provisions. For all EHB covered services provided by a Delta Dental PPO or Delta Dental Premier dentist, the maximum out-of-pocket payments are $350 per calendar year for one person under the age of 19 or $700 per calendar year per family with two or more people under the age of 19. An individual will be considered under the age of 19 until the end of the calendar year in which the individual attains the age of 19.

Certified EHB Low Plan Delta Dental PPO plus Premier

Benefits for members under

the age of 19

NoneSee above for maximum out-of-pocket details

$75/$225Applies to radiographs, basic, and major services

None

To enroll, complete the Client Information Form and return to your Account Manager at Delta Dental along with enrollment information and proof of prior dental coverage (if applicable). Client Information Form:

To download, visit the Producers section of our website atwww.deltadentalnc.com

Questions? Call us at 800-587-9514

Form No. 11003 North Carolina Client Information Form 11/2018

Please take a moment to complete this form. We will consider it, along with your group’s experience, enrollment data, and any other applicable information, when setting up your account with Delta Dental.

Absence of written approval does not imply acceptance. Depending on the plan you choose, there may be minimum enrollment requirements.

If you have any questions regarding this form or any of Delta Dental’s programs, please feel free to contact your Delta Dental representative.

CLIENT INFORMATION FORM DELTA DENTAL OF NORTH CAROLINA

Coverage or administration for your group will not start until you receive approval in writing from Delta Dental.

Client Name (as it will appear on the contract):

Client Tax Identification/EIN #:

Effective Date: Contract Length: 1 year 2 years 3 years Other:

Physical Location:

City: State: ZIP Code: County:

Do you need a plan that complies with the ACA’s Essential Health Benefits (EHB)? Yes No

CLIENT OFFICER INFORMATION Same as Client Physical Location

Mr. Mrs. Ms. Dr. First Name: Last Name:

Title:

Contact Type: General Renewal

Telephone: ( ) Ext: Cell: ( ) ________________________

Fax: ( ) Email Address:

Address:

City: State: ZIP Code:

CLIENT CONTACT INFORMATION Same as Client Physical Location


Title:

Contact Type: Renewal Billing Mailing Materials Overage Dependent

Telephone: ( ) Ext: Cell: ( )


Address:


OTHER CLIENT CONTACT INFORMATION (if the billing contact is different from above) Same as Client Physical Location


Title:

Contact Type: Billing Overage Dependent

Telephone: ( ) Ext: Cell: ( )


Address:


CLIENT - BENEFIT MANAGER TOOLKIT REGISTRATION

Update your group’s eligibility online, real time, using our Web-based tool, Benefit Manager Toolkit (BMT). With BMT you can enroll a new member, update existing members, view eligibility and your benefits, print dentist directories, and access flexible and convenient reports (if your group qualifies for reports). In addition, your monthly invoice and other billing details are provided to you through BMT.

Select one individual within your company to be your Client Administrator and complete the information below. This administrator will be able to create and maintain your accounts as well as create BMT user accounts for additional individuals within your company. Delta Dental will send your administrator an email with registration information and additional instructions.

Administrator Name: ________________________________Title: __________________________________

Email: ____________________________________ Phone Number:_________________________________

Note: BMT Administrator must be an employee of the client.

AGENT/AGENCY - BENEFIT MANAGER TOOLKIT AUTHORIZATION

I authorize that the assigned Agent/Agency (including General Agents) requires access to the benefit manager toolkit as indicated.

Please indicate the type of access for the assigned Agent/Agency.

Type of Access:

UPDATE AND VIEW ELIGIBILITY NO AGENT ACCESS

VIEW ELIGIBILITY ONLY

BILLING DETAILS

CLIENT KNOWLEDGE* CLAIMS DETAIL REPORTS-ASO*

*Client Knowledge and Claims Detail Reports may not be available to your group**Please note: default access is Billing and Update and View Eligibility.

Note: The Agent/Agency is responsible for the registration and creation of their BMT account(s).

Authorized Signature:_________________________________Date:_________________________________

ADDITIONAL INFORMATION

Prior Carrier? Yes No

(IF YES, PLEASE PROVIDE A COPY OF INVOICE OR BENEFIT SUMMARY FROM PRIOR CARRIER)

Name of Prior Carrier: ____________

Is more than one plan being offered? Yes No

BILLING CONFIGURATION

Bill Type (How would you like to receive your bill?): Mail (default) Electronic Only (via BMT)

SUBCLIENT INFORMATION

The account structure is used for reporting and accounting purposes. Delta Dental will assign a client number. Subclient names/numbers will be assigned unless directed otherwise. If you prefer to modify, please note that subgroup numbers consist of four digit numeric or alpha

characters.

Please review the Dental Account Structure below carefully. Same as Client Physical Location

SUBCLIENT NUMBER SUBCLIENT NAME SUBCLIENT TIN (if different)

Note: If a Subclient has an Address or Contact that is different than the client, please provide that information below.

ELIGIBILITY AGE LIMITS FOR DEPENDENT CHILD(REN)

What age does dependent child(ren) coverage end:

Child Max Age:

Student Max Age:

IRS Max Age:

When does dependent child(ren) coverage end? To Birthdate End of Birth Month End of Year

COB PROCESSING INFORMATION

Support Internal COB (Spouses with the same employer can cover each other): Yes No

Support External COB (Spouses with different employers can cover each other): Yes No

Payment Option Type: Standard Carve-Out/Non-duplication (ASO Only)

SUBSCRIBER DEFINITION (by subclient, if applicable) Example: All full-time employees of the Contractor working at least 30 hours per week, who choose the dental plan and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees, if applicable. Use Example if no, please use below.

NEW EMPLOYEE/MEMBER WAITING PERIOD Example: On the first day of the month following 90 days of employment. Use Example if no, please use below.

TERMINATION LANGUAGE (when should coverage end)

Term on Date of Termination Term at End of Month (default)

DOMESTIC PARTNER COVERAGE

Domestic Partner Covered? Yes No

*REQUIRED* EMPLOYEE PARTICIPATION VERIFICATION

I verify that all of the individuals eligible for dental coverage have been given the opportunity to enroll in the dental plan offered by Delta Dental. For the undersigned employer, I certify that the number of eligible and enrolled employees for this dental plan as of this date is:

Status Number Eligible for Dental Number Enrolled

Full-Time Employees

Part-Time Employees

Retirees

If a segment has members but they are not eligible for coverage, enter zero for the number eligible.

Please confirm the percentage that the employer contributes for employees and dependents:

% Employer Contribution for Employee

% Employer Contribution for Dependents

HIPAA Group Health Plan Certification

The _________________________________________________________ Group Health Plan (“Plan”), through its fiduciary, does hereby certify to the following:

1. That the Plan is a “group health plan” within the meaning of the Health Insurance Portability andAccountability Act of 1996 (“HIPAA”).

2. That the Plan documents you distribute to employees informing them about their benefits or thePlan documents you are legally required to maintain for your employee benefits plans have beenamended, as required by 45 CFR 164.504(f) of HIPAA, to incorporate the following provisions andyou, as the Plan Sponsor, agreed to:

a. Not use or further disclose health information protected under HIPAA (“PHI”) other than aspermitted or required by the plan documents or as required by law;

b. Ensure that any agents, including subcontractors, to whom you provide PHI agree to thesame restrictions and conditions that apply to you with respect to such information;

c. Not use or disclose PHI for employment-related actions and decisions;d. Not use or disclose PHI in connection with any other benefit or employee benefit plan;e. Report to Plan’s designee any PHI use or disclosure that you become aware of that is

inconsistent with the uses or disclosures provided for;f. Make PHI available to an individual based on HIPAA’s access requirements;g. Make PHI available for amendment and incorporate any PHI amendments based on HIPAA’s

amendment requirements;h. Make available the information required to provide an accounting of disclosures;i. Make internal practices, books and records relating to the use and disclosure of PHI received

from the Plan available to the Secretary of the U. S. Department of Health and HumanServices to determine the Plan’s compliance with HIPAA;

j. Ensure that adequate separation between the Plan and the Plan Sponsor is established asrequired by HIPAA (45 CFR 164.504(f)(2)(iii)); and

k. If feasible, return or destroy all PHI received from the Plan that you, as the Plan Sponsor, stillmaintain in any form and retain no copies of such PHI when no longer needed for thespecified disclosure purpose. If return or destruction is not feasible, you will limit further usesand disclosures to those purposes that make the return or destruction infeasible.

3. The undersigned further certifies that he or she has the authority to sign on behalf of the Plan.

Printed Name of Plan Fiduciary Representative Delta Dental Group Number(s)

Signature of Plan Fiduciary Representative Date

OR We decline to sign this Group Health Plan Certification and will not create, maintain, receive or access PHI for our group members.

Printed Name of Plan Fiduciary Representative Delta Dental Group Number(s)

Signature of Plan Fiduciary Representative Date

Please fill in the name of your group health plan, sign and date this Certification, and return one original to Delta Dental, P.O. Box 30416, Lansing, MI 48909.

FOR AGENTS ONLY

Primary Agent Name:

Social Security Number:

Primary Agency Name:

TIN:

Checks to: Agency Agent

YOUR SOCIAL SECURITY NUMBER IS REQUIRED BY THE STATE FOR APPOINTMENT.

Address:


Is there more than one Agent? Yes No (Attach complete agent information)

If yes, what is the percentage of the total commission for each agent?

Primary Agent: % Secondary Agent: %

STANDARD COMMISSION SCHEDULE

GROUP SIZE STANDARD PERCENT OF PREMIUM OR ADMINISTRATIVE FEES & CLAIMS PAID

2 to 99 subscribers 10.00% 100 or more subscribers Negotiated on a client-by-client basis

Standard (marked in grid) Flat %

Start Date:

Agency or Agent shall disclose in writing to the client, in advance of the purchase of business, the nature of any compensation the Agency or Agent will or may receive or be eligible to receive from Delta Dental in connection with the placement or servicing of the client's business, as well as the nature of any other material business relationship between the Agency or Agent and Delta Dental. This requirement is a condition to eligibility for receiving compensation under Delta Dental's agency/agent compensation program as described in Delta Dental's Agency/Agent Agreement. Delta Dental will report to Agent's or Agency's designated clients all compensation paid to Agency or Agent for work performed on behalf of such clients. By signing this form I warrant and represent that I have made full disclosure to the client of any and all compensation I may receive from Delta Dental related to the client's purchase of a Delta Dental benefit plan.

Agent’s Signature: Date:

FOR AGENTS ONLY

Secondary Agent General Agent

Secondary Agent Name:

Social Security Number:

Secondary Agency Name:

TIN:

Checks to: Agency Agent

YOUR SOCIAL SECURITY NUMBER IS REQUIRED BY THE STATE FOR APPOINTMENT.

Address:


Commission Type: Flat Standard

Commission Start Date:

Commission Percent: %

Agency or Agent shall disclose in writing to the client, in advance of the purchase of business, the nature of any compensation the Agency or Agent will or may receive or be eligible to receive from Delta Dental in connection with the placement or servicing of the client's business, as well as the nature of any other material business relationship between the Agency or Agent and Delta Dental. This requirement is a condition to eligibility for receiving compensation under Delta Dental's agency/agent compensation program as described in Delta Dental's Agency/Agent Agreement. Delta Dental will report to Agent's or Agency's designated clients all compensation paid to Agency or Agent for work performed on behalf of such clients. By signing this form I warrant and represent that I have made full disclosure to the client of any and all compensation I may receive from Delta Dental related to the client's purchase of a Delta Dental benefit plan.

Agent’s Signature: Date:

Enrollment/Corrections to Information (please fi ll in for spouse/dependents for fi rst-time enrollment or corrections):SPOUSE Name (Last) (First) (M.I.)

Social Security Number Birth Date Status*

DEPENDENT #1 Name (Last) (First) (M.I.)








Subscriber Information (please complete for all enrollments/updates:) Example:Subscriber Name (Last) (First) (M.I.)

Subscriber Social Security Number Birth Date Status* Coverage Effective Date

Street Address Email

City State ZIP Code

– –

Eligibility Enrollment/Update

ABCDEF12 43 56Sex

MaleFemale

– – Active COBRARetiree Surviving

– –

Check here if thisis a new address

–

Plan Enrollment/Update Information (please indicate type of update and fi ll in appropriate information):

Type of Update: New Enrollment Reinstatement Change/Correction to Information Termination of Benefi ts Waive Benefi tsGroup Transfer Rate Code Change* Change is for:From: Client/Subclient# To: Client/Subclient# From: To: Effective Date of Change Subscriber Dependent– –– –

SexMaleFemale

– – Legal Surviving– –

SexMaleFemale

SexMaleFemale

IRS Dep. SurvivingDisabled Sponsored


– – – –

– – – –

SexMaleFemale


– – – –

SexMaleFemale


– – – –

Client Name: ____________________________________________ Client#/Subclient#

Check: Indiana Michigan North Carolina Ohio

*See reverse side for instructions and explanation of codes. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or fi les a claim containing a false or deceptive statement is guilty of insurance fraud.

Subscriber’s Signature_________________________________________ Date _________________________1314-55 (12-13)

–

Please read the following information carefully before completing the other side of this form. You should fi ll out this form if you are enroll-ing for coverage or changing any information from an earlier enrollment. If you have any questions about fi lling out this form, your human resources or personnel department can help you.

Subscriber Information – This section must be completed for us to process your enrollment or update your records. All information should apply to you, the primary subscriber. Please print clearly or type.

Effective Date: The date that Delta Dental coverage takes effect for you and/or your dependents.

Status Defi nitions (Please select only one status):

Active: You are a current/active subscriber.

Retiree: You are retired and your group continues to provide you with dental benefi ts.

COBRA: You are no longer an active subscriber but you have continued self-paid coverage under COBRA. COBRA requires many employers to offer extended self-paid coverage to certain employees and qualifi ed benefi ciaries who lose group medical benefi ts coverage. Please check with your human resources or personnel department.

Surviving: The surviving spouse or child of a deceased subscriber.

Plan Enrollment/Update Information – This section should only be completed if you are: (1) Enrolling yourself or a family member for the fi rst time, or (2) if your benefi ts were terminated and are not being reinstated or, (3) if you are making changes to yourcurrent enrollment information.

Enrollment: Check for fi rst time enrollment for yourself or your dependents.

Reinstatement: Check for reinstatement coverage for yourself or your dependents.

Change/Corrections: Check if any changes are being submitted on the form.

Termination of Check only if you are terminating Delta Dental coverage forBenefi ts: yourself or a family member.

Group Transfers: When transferring from one group to another, all dependents will transfer unless otherwise indicated.This section should also be completed when transferring to COBRA.

When reporting a change or correction, the information that is incorrect or has changed should be listed on the line titled “from” and the correct information should be listed on the line titled “to”.

When changing a rate code, please refer to the following explanation to select the code that describes who is being covered by your Delta Dental program.

Rate Codes:Rate 1 Employee OnlyRate 2 Employee and spouseRate 3 Employee, spouse and childrenRate 5 Employee, one child, no spouseRate 6 Employee and more than one child, no spouse

Enrollment/Corrections To Information – This section should be completed when: (1) enrolling dependents or, (2) if you have checked Changes/Corrections and are changing information that was previously submitted to Delta Dental. Please include both fi rst and last names of any individuals for whom you are enrolling or submitting a change or correction.

Dependent Status Defi nitions:

Legal: Your current spouse

Surviving: The surviving spouse or child of a deceased subscriber.

IRS Dependent: An individual who is your dependent child according to the U.S. Internal Revenue Code. This could includeyour unmarried dependent child who is attending a university, college, community college, junior college ortrade school on a full-time basis and for whom you provide principal support.

Disabled: Your permanently disabled child.

Sponsored: A dependent for whom you are legally responsible. Sponsored dependents could include parents, grandparentsand foreign exchange students, but only if specifi ed in your group’s contract with Delta Dental.

Delta DentalAttention: Eligibility ProcessingPO Box 30416Lansing, MI 48909-7916

Stay in network and saveAs a Delta Dental PPO plus Premier member, you may see any dentist you like. However, there are advantages to choosing a dentist who belongs to one of Delta Dental’s two dentist networks.

Delta Dental PPOSM dentists

• No balance billing on covered services• Most significant network discounts with nearly 1,900 dentists in North Carolina• Dentists file claims for member

Delta Dental Premier® dentists

• No balance billing on covered services• Significant network discounts with more than 2,900 dentists in North Carolina• Dentists file claims for member

Out-of-network dentists

• May be balance billed• No network discounts• May need to file own claims

How it works—As shown below, your lowest out-of-pocket costs result from going to a Delta Dental PPO dentist.

Example savings for a crown by network Estimated

chargeMaximum

allowed feesPercentage

paid by Delta Dental

Amount Delta

Dental pays

Amount dentist can balance bill

Totalamount you pay

Your total cost savings

Delta Dental PPO $1,500 $900 50% $450 $0 $450 $600

Delta Dental Premier $1,500 $1,000 50% $500 $0 $500 $500

Out-of-network $1,500 $1,200 50% $600 $300 $900 $0

Delta Dental PPO dentists Delta Dental Premier dentists Out-of-network dentistsDelta Dental PPO dentists have agreed to charge $900 for the $1,500 service, a savings of $600. Your Delta Dental plan covers 50 percent of the cost. Assuming you’ve already met your deductible for the year, Delta Dental will pay $450 and you’ll pay $450.

Delta Dental Premier dentists have agreed to charge $1,000—a savings of $500 compared to the fee the dentist usually charges. Assuming you’ve met your deductible, Delta Dental will cover 50 percent of that $1,000, paying $500. You’ll also pay $500. That’s an extra $50 tacked on to your share of the bill when compared to what you would have paid with a Delta Dental PPO dentist.

Out-of-network dentists have not agreed to charge lower fees and can bill the full $1,500. Delta Dental has set a limit on the accepted amount at $1,200, which means Delta Dental’s share of the tab is $600. The dentist can bill you the difference between Delta Dental’s payment and what they charge. This leaves you with a bill of $900, which includes the $300 the out-of-network dentist can “balance bill.”

NOTE: Payment examples above are illustrative only. Fees and reimbursements can vary by location and dentist. They do however represent how payment is determined.

Find Delta Dental participating dentists near you by using the search feature on our website at www.deltadentalnc.com/findadentist, or by calling Delta Dental toll free at 800-662-8856.

6241-NC v2 PA 6/16

Find a Delta Dental Participating DentistYour Delta Dental PPO plus Premier plan allows you to visit any dentist you like. However, there are advantages to choosing a dentist who belongs to one of Delta Dental’s two dentist networks. You can save the most money and receive the highest levels of coverage when you visit a Delta Dental PPOSM dentist.

If you visit a dentist who does not participate in Delta Dental PPO, you can still save money if that dentist participates in Delta Dental Premier®.

To find a participating dentist in your area, follow the simple steps below.

2

» Step 1Visit www.deltadentalnc.com. Click one of the links to Find a Dentist.

You may also go directly to www.deltadentalnc.com/findadentist.

» Step 2 Click the Start Your Dentist Search button.

1

www.deltadentalnc.com/findadentist

OVER

» Step 3The Specialty menu defaults to any dentist. If you want to search for a specific specialty, select the specialty from the drop-down menu. Then, select the Your plan menu and choose the appropriate network option for you.

• Delta Dental PPO—all providers who participate in Delta Dental PPO.

• Delta Dental Premier—all providers who participate in Delta Dental Premier.

• Delta Dental PPO plus Premier—all providers who participate in both Delta Dental PPO and Delta Dental Premier.

The search will display results that fit your criteria, and whether or not those providers also participate in other networks.

Next, select Yes to search by current location or No to search by address or ZIP code. Choosing “Yes” may require you to change a location setting or you may need to go back and select “No” and manually enter your physical address if you receive an error message.

Select Find dentists to begin search.

» Step 4Your results will be displayed. You can change your original search criteria for specialty, network, and address at the top of the page or sort your results by distance and number of results. By selecting More options you will see additional search criteria such as extended hours, accepting new patients, languages spoken and gender. You can also search for a specific dentist by name or office name. Once you have selected all of your search criteria, select the green Submit box to get your search results.

In addition to viewing your search results online, you can print or email your results, or view your results as a PDF under My list. To add dentists to your list, select the Add to my list or Add all to my list checkboxes.

Once you have added results to your list, select the down arrow to save as a PDF, print or email your list.

FLI-6299-NC v2 PA 7/18

www.deltadentalnc.com/findadentist

4

Unsure of your plan type or looking for additional information?

Register or log in to the Consumer Toolkit®, Delta Dental’s secure online tool for access to eligibility information, current benefits information, claims information and more.

Learn more at www.deltadentalnc.com/consumertoolkit.

All users must first register to gain access to the Consumer Toolkit. Privacy of your online benefit information is assured through highly secure encryption technology.

Get started today

1. Visit www.consumertoolkit.com.

2. Click the Register Now link.

3. Complete the required fields and follow the on-screen instructions to register as a new user.

• NOTE: You will need the subscriber’s (the person whose name is on the benefit package) member ID. The member ID is an assigned number unique to the subscriber. In many cases, the member ID is the same as the subscriber’s Social Security number.

4. Select your own username and password to access the site.

Additional help topics can be accessed through the Help menu or by clicking the question mark icon at any time within the Toolkit. If you need further assistance, contact Toolkit Support at 866-356-0301.

Stay informed about your dental benefits with Consumer Toolkit®

Consumer Toolkit is designed to give you 24/7 access to important information regarding your dental benefits.

Use this secure online tool for access to eligibility information, current benefits information, claims information and more.

Once you have logged in to the Consumer Toolkit, remember to sign up for electronic delivery of Explanation of Benefits (EOB) statements. You will be able to view your EOBs online and print copies when necessary.

FLI-6333 v1 PA 6/16 Delta Dental of Arkansas, Indiana, Kentucky, Michigan, New Mexico, North Carolina, Ohio, and Tennessee.

Your Benefits, at Your Fingertips!The Delta Dental Mobile App helps you get the most out of your dental benefits anytime, anywhere. Use the dentist search or toothbrush timer without logging in, or enter your username and password to securely access your personal benefit information or estimate your dental care costs.

» Coverage and claims information

See your plan type, benefit levels, deductibles, maximums and more. Check the status of recent dental claims. Add your dependents to your account to be able to access the whole family’s coverage in one spot.

» Dental Care Cost Estimator

This easy-to-use tool provides estimated cost ranges on common dental care needs for dentists in your area. You can even select your dentist for tailored cost estimates.

» Dentist search

It’s easy to find a participating dentist near you! Search and compare dental offices to find one that suits your needs. Narrow the list with criteria like ‘language spoken’ and ‘specialty.’ After you choose a dentist, you can save the contact information and get directions.

» Mobile ID card

There’s no longer a need to carry a paper ID card. Simply show the dentist’s office your mobile ID card right on your screen. Easily save it to your device for quick access using Apple Passbook or Google Wallet.

» Toothbrush timer

Keep up with your oral health routine by using this handy tool. Our timer counts down for two minutes while reminding you to brush each tooth.

Get startedDelta Dental’s free app is optimized for iOS (Apple) and Android devices. To download our app on your device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental. Or, scan the QR code at right.

Log in for secure accessDelta Dental subscribers can log in using the username and password used to log in to www.deltadental.com. If you haven’t registered for an account yet, you can do so within the app. If you’ve forgotten your username or password, you can also retrieve these within the app. You must log in each time you access the secure portion of the app. No personal health information is ever stored on your device.

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DELTA DENTAL PLAN OF NORTH CAROLINA

Small Group Dental Solutions...Minor restorative services, periodontal maintenance, simple...

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