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State Dental Plan Frequently Asked Questions (FAQs)
Do I need to visit a specific dentist?
No. The State Dental Plan provides you the opportunity to see any provider you choose, regardless of whether that provider participates in Delta Dental’s networks. While you can visit any provider, you will save the most money by visiting a dentist from one of two provider networks: Delta Dental PPO and Delta Dental Premier®.
The difference between the two networks is that you will receive greater savings when you receive care from a Delta Dental PPO network provider. This is because providers who participate in the Delta Dental PPO network agree to accept the lowest fees as payment in full. If you choose to visit a Delta Dental Premier® provider, you will still receive the same protections and coverage as you would with a Delta Dental PPO provider, but it may cost more, as the Delta Dental Premier® providers accept a different fee schedule as payment in full.
If you see a dentist who does not participate in either the Delta Dental PPO or Delta Dental Premier® network, you will still be covered, but you may have to pay more. In this case, Delta Dental would pay you directly based on the dentist’s submitted fee or Delta Dental’s nonparticipating dentist fee, whichever is less. You would be responsible for paying the dentist whatever he or she charges, and you may have to submit your own claims.
Where can I find a participating dentist or see if my current dentist participates?
You can find participating dentists by visiting the Delta Dental website at www.deltadentalmi.com and clicking on Find a Dentist. You can also call Delta Dental’s Customer Service department at 800-524-0150.
Does everyone in my family have to use the same provider?
No. You and your family can see any provider you choose. You do not have to select the same provider. Individual family members can select their own provider.
How will my dentist receive payment?
Payment is sent directly to Delta Dental participating providers. You are responsible for any coinsurance payment that may apply.
What if I am in the middle of orthodontic treatment?
If you are a Midwestern Dental member who transitioned to the State Dental Plan, you will need to select a new dental provider to complete your orthodontic treatment. The new provider will submit a new treatment plan to Delta Dental for an estimate of coverage through the State Dental Plan. Member’s out-of-pocket expenses will vary based on whether they are a PPO, Premier, or non-participating provider.
Note: The State Dental Plan’s payment for orthodontic services will not exceed a lifetime maximum of $1,500 per eligible person.
Do I need an ID card to receive treatment?
No. Although you will receive an ID Card with an Alternate ID on your initial enrollment with Delta Dental, ID cards are not required to receive treatment. Your dentist can verify your coverage at the time of the appointment by contacting Delta Dental.
What if I have a dental emergency?
Under the State Dental Plan, you can see any provider at any time, and treatment will be paid based on the specific provider you have chosen. Member’s out-of-pocket expenses will vary based on whether the provider is a PPO, Premier, or non-participating provider.
How can I receive a copy of my dental records from Midwestern Dental?
Please contact your former Midwestern Dental office of record and follow the prompt for records request, where you will be able to request a copy of your records.
If I have billing questions related to my Midwestern Dental coverage, who do I call?
For all Midwestern Dental billing related matters, please contact their Central Billing Office at 732-750-5229 or 732-750-5228.
Where can I find information about my plan and coverage levels?
Once you are enrolled in the State Dental Plan, you can review your eligibility status, claims information, and benefits by visiting the Delta Dental Consumer Toolkit® at www.deltadentalmi.com. This toolkit will also enable you to print your own ID cards and can provide you with oral health tips.
Do I need a referral to see a specialist?
No. You can see any provider you choose, including specialists. Member’s out-of-pocket expenses will vary based on whether they are a PPO, Premier, or non-participating provider.
What if I have other questions about the State Dental Plan?
If you have other questions about your dental benefits, please contact Delta Dental’s Customer Service department at 800-524-0150.