Frequently Asked Questions for Producers

Producers frequently asked questions

What’s the minimum group size required for a quote?

The minimum group size for our plans is 10 employees. However, we also offer standardized plan options for small businesses with two to nine eligible/enrolled employees. Rates for these group segments are pooled for best overall savings.

What’s the minimum contribution level from the employer?

The minimum contribution level from the employer is 50 percent of the employee rate, unless you are selling a voluntary program.

How many employees are required to quote orthodontics?

We require a minimum of 25 employees before we will quote orthodontics, unless the group had orthodontic coverage through their previous carrier.

Are there any waiting periods for services?

No. Delta Dental does not have waiting periods for services, except for our voluntary plans.

Does Delta Dental have a pre-existing condition clause?

No. Delta Dental’s programs have no exclusions or limitations for pre-existing conditions.

Explain Delta Dental’s position on Certificates of Portability.

Dental is excluded unless the medical and dental are tied together. Since Delta Dental underwrites plans on a stand-alone basis, the aspects of HIPAA concerning certifications of creditable coverage do not apply. (Also, Certificates of Portability were created to address pre-existing condition clauses. Delta Dental does not underwrite plans with pre-existing condition clauses.)

Do members experience balance billing with Delta Dental?

No. Delta Dental members are responsible only for their copayments, deductibles and charges for noncovered services, if any, when they visit a participating Delta Dental dentist. Our participating dentists agree to accept our fee determination as full payment for covered services.

What materials will the members receive after the program is implemented?

Our standard materials include a program certificate booklet along with a summary of dental plan benefits describing the coverage levels. Additionally, the group will receive an administrative manual, eligibility enrollment forms, a dentist directory (if applicable), and a re-order form for materials.

What are the commissions paid by Delta Dental?

Delta Dental offers a flat percentage based on group size. Please see our contract or Agent Commission Schedule. Outside of this schedule, commissions can be determined on a group-specific basis, subject to rating adjustment.

Explain the methods of reporting eligibility.

Methods of reporting eligibility include online, tape, enrollment forms, diskettes and forms used by some other carriers.