Effective Date Revised Combined Evidence of Coverage and Disclosure Form EOC Provided by: Delta Dental of California 560 Mission Street, Suite 1300 San Francisco, CA 94105 800-471-0287 deltadentalins.com CoveredCA.com 800-300-1506 NOTICE: THIS EOC CONSTITUTES ONLY A SUMMARY OF YOUR GROUP DENTAL … COVERAGE IN ORDER TO UNDERSTAND THE DETAILS OF YOUR DENTAL COVERAGE . coverage with Delta Dental of Kentucky PPO Plan. Delta Dental PPO Benefits Summary Administered by Delta Dental of Rhode Island Pre-treatment estimate recommended Dependent coverage: Dependent children are covered up until the end of the month that they turn age 26. Dependent has coverage through Medicaid. for Small Businesses [Group Name] [Group No.] In-Network Coverage In-network diagnostic and preventive services are covered nationwide at 100% — which means that you won’t have any additional out-of-pocket costs for those procedures nationwide when visiting a Delta Dental PPO … Follow our simple, three-step registration process and log in to our secure system to see your eligibility information and benefits details. EVIDENCE OF COVERAGE IN ORDER TO UNDERSTAND THE DETAILS OF YOUR DENTAL COVERAGE . Predeterminations are not required, but Delta Dental … PPO PREMIER NON–DELTA DENTAL … Getting affordable dental coverage is easier than ever with a Delta Dental PPO¹ plan. That’s because PPO dentists agree to accept lower reimbursements for services. • Coverage for major services (crowns, root canals, dentures, bridges, partials, implants, tooth removal, gum disease treatment) • Coverage for dependents up to 26 years old Convenience On average, we save our members 23% on covered dental services.4 When you’re selecting a dental insurance plan, focus on choice, care, savings and convenience. Permanente, you receive dental coverage for preventive services. Group- and state-specific exceptions may apply. If you began treatment prior to your effective date of coverage, you or your prior carrier will be responsible for any costs. Your Subscriber Benefit Booklet will provide you with additional information about your Delta Dental plan, including information about plan exclusions and … Your Co-Payment, Maximums and Waiting Periods . Coverage will become effective on the Group's Anniversary Date. Welcome! This document contains a list of available services under this plan. It's easy to look up your benefits online, including your dentist network, maximums and deductibles, copayment percentage for standard and orthodontic coverage, and other details. Dependent has coverage … Delta Dental of Kansas Dual Coverage Processing Guidelines. The Delta Dental PPO* plan makes it easy for you to find a dentist, and easy to control your costs when you visit a network dentist. 1 In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan. It reflects and is subject to a contract between Delta Dental and the Contractor. Delta Dental Premier Delta Dental’s national fee-for-service dental benefits program that covers you when you go to a non-PPO Dentist. … Some but not all health plans offer dental coverage. Delta Dental PPO . Delta Dental PPO™ Delta Dental Premier® Coordinate two plans with dual coverage Best of Both How does dual coverage help me save? 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