Broker blog from Delta Dental

Tag: benefits (Page 1 of 3)

Take the mystery out of dental expenses with the Cost Estimator

Your group clients’ members are busy enough, so trying to figure out how to budget their dental care shouldn’t become a second job. That’s why we created the Cost Estimator, a tool available for desktop and mobile that members can use to estimate quickly and easily what their next dental visit will cost.

What’s more, the Cost Estimator has just been refreshed with a new, accessible and mobile-optimized design.

How can the Cost Estimator can help members?

The Cost Estimator provides members with a personalized estimate (based on the fee schedule from the last dentist from whom they received service) for an entire dental visit with a specific dentist. It calculates members’ out-of-pocket costs based on their current benefits. Information is updated daily, so members can always count on getting an accurate cost estimate.

This versatile and easy-to-use tool offers members a variety of useful features and information to help them make the most of their benefits and helps them become better informed consumers.

In the tool, clients can choose from a list of common dental procedures ― they can even specify which tooth needs treatment or what type of filling they’d prefer! After they select their procedure, the Cost Estimator calculates their estimated out-of-pocket cost. The tool subtracts both the network savings and the portion the plan pays.

Other tasks your clients can perform with the Cost Estimator include:

  • Adding procedures. If clients need to add services such as a cleaning or x‑rays to their visit, they can add them to their estimate to get the total cost of the visit.
  • Comparing dentists. Clients might be curious to see if they’d save by switching to another dentist. The Cost Estimator lets them compare up to five in-network dentists to find the best deal.
  • Selecting plan members. Clients can get cost estimates for anyone on their plan, such as spouses and children.
  • Reviewing benefits usage. Clients can access the benefits activity and history for everyone on their plan, and can also review their plan’s maximums, deductibles and out-of-pocket limits.

How can the Cost Estimator help my group clients’ bottom line?

The Cost Estimator provides members with transparency about their out-of-pocket costs. More cost transparency can mean fewer questions and less confusion about the value of visiting an in-network dentist. By showing the substantial cost differences between in-network and out-of-network dentist visits, the tool encourages in-network utilization — which can help members save and may help lower group dental plan costs.

Which clients can use the Cost Estimator?

All Delta Dental PPO™ and Delta Dental Premier® groups are eligible to sign up for the Cost Estimator. DeltaCare® USA members receive a plan booklet with their copayments for covered services, so this tool isn’t necessary for DeltaCare USA plans.

If you have group clients that haven’t taken advantage of the Cost Estimator, explain to them the cost-saving benefits of this tool. For details, talk to your Sales representative about how your clients can add this service to their plan.

How do members access Cost Estimator?

To use the Cost Estimator, members simply click Plan ahead for a visit from the member portal. PPO and Premier members can also access a more limited version of the Cost Estimator through the Delta Dental mobile app, which details in- and out-of-network fees.


With the Cost Estimator, your clients can be confident that their members are not only about staying within their budgets, but also that they’re getting the best deal for themselves and their families. Be sure your group clients don’t miss out on this valuable resource.

Twice as nice: dual coverage

Are your clients aware of dual coverage and how it works? If not, they could be missing out on substantial savings on their dental care.

Dual coverage (or coordination of benefits), as the name implies, is when a person is covered under two dental plans. This doesn’t mean double coverage, however. Both plans won’t fully cover each approved procedure. In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.

Why would my clients have dual coverage?

There are several scenarios in which a client may have dual coverage:

  • A client and his or her spouse both have employer-sponsored coverage
  • A client has two benefits-eligible jobs

That’s good to know! How do my clients know which is their primary carrier?

Your clients and their dependent children may be eligible for dual coverage. Which insurance carrier is the primary depends on several factors.

For clients, the primary carrier depends on whether the client also has dental coverage through a spouse or domestic partner:

  • If the client does, the primary carrier is the one provided by his or her employer.
  • If the client doesn’t, but currently has two jobs that provide dental coverage, the primary carrier comes from whichever employer has provided coverage for the longest time. If the client has coverage through a current and former employer, the current employer’s plan is primary.

For dependent children, the primary carrier depends on whether the child’s parents are married and live together.

  • If they are (or have joint custody), the primary carrier is through the parent whose birthday falls earlier in the year. (If both parents have the same birthday, the primary carrier is the one that’s provided coverage for the longest time.)
  • If they aren’t and don’t have joint custody, the primary carrier is though the parent who has legal custody of the child.

Is there anything else my clients should know about dual coverage?

Yes. For starters, dual coverage applies only to group plans, not individual plans. Group plans can coordinate benefits only with another group plan.

If one of the plans covering the claim is an individual dental plan, that plan will always pay coverage as primary. Individual plans can’t coordinate benefits with other individual plans, either. In that situation, all plans will pay as primary.

Also, if employees have dual coverage, they must inform their dental office of both plans before they receive treatment. (Failure to do so could be considered insurance fraud!) Once they do, we’ll coordinate the cost sharing with the employee’s other plan.

An important caveat is whether the client’s secondary policy has a non-duplication of benefits clause. While this clause won’t negate their dual coverage, it means the coverage will provide less benefit than standard dual coverage would.

For example, if a client has dual coverage in which the primary carrier covers 50% of a procedure and the secondary carrier covers 80%, then 100% of the cost of the procedure would be covered. However, if the secondary carrier has a non-duplication clause, then only that carrier’s 80% would be covered.

Clients should also be aware that they’re still responsible for amounts that exceed maximums, charges above the allowed amount if using an out of network provider and charges for non-covered services.

Finally, dual coverage involving an HMO-type plan such as DeltaCare® USA can be complicated. Clients can contact Delta Dental Customer Service for details if they have dual coverage involving two HMO-type plans or a PPO and HMO-type plan.

Does Delta Dental have dual coverage resources for my clients?

Yes. Your clients can refer to the dual coverage information available on the Delta Dental member site.

Dual coverage at first may seem confusing, but with some guidance and our resources, your clients can enjoy maximum saving with minimum hassle.


Note: This post was updated to specify that dual coverage applies only to group plans and doesn’t apply to individual plans.

3 reasons customers are seeking dental insurance now

The pandemic has changed how we work, how we interact and even how we think about our health and safety. As consumer attitudes toward oral health have changed, dental insurance has become more important than ever. Here are some of the reasons that employers and individuals alike are seeking out dental benefits in 2022 and how you can help meet the new demand.

1. Competitive benefits help employers combat the Great Resignation

The pandemic has triggered an exodus from the workforce that economists have labeled the “Great Resignation.” One of the top reasons employees are giving for leaving a position is lack of adequate benefits. 

As the pandemic reshapes the labor market, companies must rethink and retool their benefit offerings to attract and retain talent. About 37% of employees in a recent survey said they value stronger benefits over additional salaries or bonuses, and they consistently rank dental insurance as one of the most important benefits in making a job decision.

Employers who offer dental insurance want a plan that stands out. With Delta Dental, you can help your group clients create plans with the attractive added benefits that employees are seeking now, like maximum waivers for diagnostic and preventive services and coverage for popular but costly services like implants and orthodontics.

2. Dental health needs have grown

The pandemic has also had a direct effect on oral health, creating another reminder of the value of dental insurance. A 2021 survey conducted by the American Dental Association showed a major increase, up to 71%, in stress-related oral health conditions during the pandemic, and more than a quarter of the dentists surveyed reported an increase in cavities and gum disease, as well.

Even in the midst of the pandemic, those with insurance remained more likely to visit the dentist than those without, thereby increasing the likelihood for positive health outcomes when faced with these new challenges.

Companies are seeking to bulk up their benefits to attract and retain employees, and workers are likewise seeking strong dental packages to handle the health issues arising due to the pandemic. Match clients with the dental coverage they’re looking for with Delta Dental PPO™ and DeltaCare® USA plans, which can meet these new demands and reduce the chances for serious (and expensive) health issues down the line.

3. Patients value teledentistry as an option

Fear of returning to the dentist caused teledentistry to boom during the pandemic, with more patients using the technology than ever before. For instance, Delta Dental’s synchronous and asynchronous teledentistry claims in 2021 were six times and two times higher than 2019 levels, respectively.

Many consumers grew accustomed to using teledentistry during the pandemic, and they want to have it as an option moving forward for its safety and convenience. Satisfaction levels with teledentistry services during the COVID-19 pandemic were 100% in the satisfied and very satisfied categories, according to one recent study, and 96% of participating patients in another study said they would use the service again.

When your clients are covered under a Delta Dental PPO or Delta Dental Premier plan, they have two options for free-to-access, easy-to-use teledentistry platforms:

  • Virtual Consult. Offers patients a consultation with a Delta Dental dentist about dental issues over live video.
  • Toothpic. Offers patients a format to submit photos to receive personalized treatment recommendations from a Delta Dental dentist within 24 hours.

And with Delta Dental, members can still see a dentist in person after choosing a virtual dentistry appointment.

Reminding clients of the convenience, popularity and safety of teledentistry can help make a comprehensive dental insurance package that much more attractive. Delta Dental plans give you access to the technology that your clients want now.

Your clients need dental benefits in a post-pandemic world

The pandemic has changed some of Americans’ central attitudes toward dental benefits. Employers are looking to add or increase benefits, and individuals have started to realize the long-term advantages of maintaining their oral health through robust coverage.

With Delta Dental, you can help your clients find affordable, highly rated coverage and a large network of experienced providers. Check out Delta Dental’s wealth of sales resources, and be sure to talk to your group and individual clients about the importance of dental insurance to help them select a Delta Dental plan that can support their overall needs.

Pre-treatment estimates help members manage their costs

Understanding the cost of dental care can sometimes be confusing. Many procedures that can be described in simple terms can have multiple costs associated with them. For example, to get a root canal, a patient would likely require multiple x‑rays, a post build-up, a crown and more. For that reason, pre-treatment estimates can help members avoid unexpected surprises.

What is a pre-treatment estimate?

Pre-treatment estimates (also known as pre-determinations or pre-authorizations) are written estimates provided by Delta Dental to members and their dentists. These estimates detail the cost share for a proposed dental treatment and are often requested before complex or expensive procedures, such as crowns, wisdom tooth extractions, bridges, dentures and oral surgery.

Pre-treatment estimates help members understand and manage their costs by breaking down complex procedures into easy-to-understand, itemized lists. They show what portion of a bill is paid by the patient and what portion will be paid by their dental plan.

Pre-treatment estimates are not binding, and factors may change in between requesting the estimate and receiving care that lead to costs being different than expected. For example, coverage may change, an annual maximum may be reached or a member may age out of a procedure with an age limitation. Pre-treatment estimates should be considered an approximation (although a very accurate one!) of the final costs of care.

How can Delta Dental members get pre-treatment estimates?

There are four steps members can take to receive a pre-treatment estimate.

  1. The Delta Dental member discusses the proposed dental treatment with his or her dentist and asks the dental office to request a pre-treatment estimate from Delta Dental.
  2. The dental office submits a treatment plan and supporting documentation (such as x‑rays) to Delta Dental for review.
  3. Delta Dental reviews the documents and the member’s benefits.
  4. Both the member and dental office receive a copy of the pre-treatment estimate from Delta Dental. This document includes a cost estimate based on the member’s plan type, eligibility, current plan benefits and the amount remaining in their annual maximum.

Pre-treatment estimates are available for members with Delta Dental PPO™, and Delta Dental Premier® and DeltaCare® USA plans. Because DeltaCare USA is a copayment plan, members will have access to a list of copayments for every covered procedure. Pre-treatment estimates may be less useful for DeltaCare USA members than for members with other plans.

Are there other resources Delta Dental offers to help members understand their costs?

Delta Dental members can also use their online account to view their current benefits and benefits usage, as well as to estimate costs. This online cost estimator isn’t as thorough as a personalized pre-treatment estimate, but it can be useful for getting a quick estimate for common procedures.

Gum disease and the overall health connection

When people want to improve their health, they often focus on improving their diet, starting an exercise program or quitting bad habits like smoking.

However, few people realize that their gums are also a crucial part of their overall well-being. Many serious health conditions have been linked to gum disease. It’s clear that oral health is integral to overall health. This February for Gum Disease Awareness Month, learn how Delta Dental coverage can support your clients’ gum health and their overall wellness.

The connection between gum disease and overall health

Gum disease, or periodontal disease, is a common bacterial infection that causes a chronic inflammation of the gums and surrounding tissue. It’s the major cause of adult tooth loss, and it affects nearly half of people over 30, according to the Centers for Disease Control and Prevention.

The effects of gum disease extend well beyond the mouth. Gum disease has been linked to a number of serious health conditions, including:

  • Heart disease, heart attack and stroke. Inflammation from bacteria in the gums may eventually lead to narrowing of arteries and heart trouble.
  • Dementia. Chronic gum inflammation can be a risk factor for Alzheimer’s disease later in life.
  • Glaucoma. Tooth loss and gum disease may increase the risk of this disease of the optic nerve.
  • Rheumatoid arthritis. The bacterium that causes periodontal disease may increase the severity of rheumatoid arthritis, lead to an earlier onset of the disease and cause symptoms to progress more quickly.
  • Diabetes. People with diabetes are at increased risk of developing gum disease. In turn, having gum disease can make your blood glucose harder to control.
  • Premature birth and low birth weight. Pregnant women are at increased risk of gum disease due to hormonal changes and increased blood flow. Gum disease is associated with an increased risk of preterm birth, as well as low birth weight and other pregnancy complications.

Preventing gum disease and treating the condition early can reduce health costs, dental treatments and medical expenses in the long term.

How Delta Dental coverage can support gum health

Delta Dental offers coverage that can help your group and individual clients avoid the onset and development of gum disease. Routine dental checkups and cleanings, covered by all Delta Dental plans as diagnostic and preventive services, can help prevent and monitor gum disease.

Treatments for gum disease, such as scaling and root planing, are typically covered under most dental plans under periodontic services. Following a scaling and root planing, a patient with gum disease may receive specialized deep cleanings for periodontal maintenance. This procedure, likewise covered under most plans, can minimize the recurrence or progression of gum disease.

However, when non-surgical treatment is inadequate, Delta Dental’s standard plans offer several surgical treatments to slow down or prevent the progression of the disease. Common procedures include:

  • Gingivectomy. Diseased gum tissue is removed and reshaped to get rid of pockets between the teeth and gums.
  • Gingival flap surgery. Gum tissue is separated from surrounding teeth and deflected back to allow a dental surgeon access to the jawbone and the root of the tooth for deep scaling and root planning.
  • Osseous surgery. Also called pocket reduction surgery, this procedure eliminates the bacteria populating the pockets by cutting the gums to remove the bacteria and repair the damaged bone.
  • Bone grafting. This procedure increases the amount of bone in a part of the jaw where bone has been lost or where additional support is needed. Bone may be taken from elsewhere in the body and surgically fused to existing bone in the jaw.

In addition, your group clients can opt in to SmileWay® Wellness Benefits which offer expanded coverage for gum treatment for members with chronic conditions, including diabetes, heart disease, HIV/AIDS, rheumatoid arthritis and stroke.

Everyone deserves healthy gums. Be sure to talk to your group and individual clients about the importance of gum health and how to select a Delta Dental plan that can support their overall health needs.

4 oral health problems teens face and how you can help

When you’re building benefits packages for your group clients, are you thinking about teenagers? With a variety of clients from individuals to groups, it’s likely your benefits package will be covering at least a few dependent teenagers. Here are some common dental concerns that teenagers face and how you can develop a better benefits package to help.

1. Cavities

With teens’ love of snacking and their inconsistent brushing habits, it should be no surprise that dental decay is the most common chronic disease in young people. Sealants are an easy way to stop cavities before they start. These thin coatings are painted on the chewing surfaces of teeth and can prevent cavities for years, which means that sealants applied during childhood can help during the teen years.

2. Misaligned teeth

Permanent teeth replace baby teeth in older children, and the jawbones can continue to grow until the end of puberty. A misalignment of the teeth and jaws may get better ― or worse ― by the time the jawbones have stopped growing.

Without coverage, prospective orthodontic patients can expect to pay between $3,000 and $6,000 depending on their age. Delta Dental plans can help cut these costs in half. Orthodontic coverage is available under all DeltaCare USA group plans and can be optionally included in any Delta Dental PPO group plan.

3. Impacted wisdom teeth

Wisdom teeth are the last teeth to develop and erupt into the mouth, usually in the late teens. Since the jaw is still growing, wisdom teeth are sometimes impacted, meaning they don’t have enough room to emerge or develop normally. Almost 5 million people get wisdom teeth removed every year in the United States.

Wisdom teeth extraction can be expensive. If it’s viable for some clients, consider building a plan that covers a higher percentage of the cost of wisdom teeth extractions. If a higher percentage of coverage isn’t a possibility, lower deductibles can help families as well, by letting them pay less out of pocket before they reach their deductible.

4. Eating disorders

About 9% of Americans will develop an eating disorder at some point in their life, often in their teenage years. Eating disorders are life-threatening conditions that can have serious consequences for oral health and overall health. They can cause nutritional deficiencies that  the mouth, as well as sensitive teeth, frequent cavities and dry mouth as a result of purging.

Dentists can be a great ally in the fight against the effects of eating disorders like bulimia (PDF) by identifying signs of the disorder, like eroded enamel and damaged gums, and offering sealants and fluoride treatments. These treatments can help reduce the damage that stomach acid causes when someone vomits. Most plans cover sealants and fluoride treatments until patients turn 15. If you’re also handling your clients’ health care package, you may also consider covering mental health treatment that can help to treat the illness altogether.

What else can you do to support teens’ dental health?

While these problems aren’t unique to adolescents, it’s still a good idea to have these in mind when considering your clients’ dental benefits. If you’re in a position to share tips with group benefits administrators, consider distributing resources that highlights plan features like teledentistry, which could be helpful for busy teens and their parents.

You can also share wellness resources like Delta Dental’s wellness library. It may be helpful to create a template email that you send to your individual clients with dependent children that highlights plan features and helpful information to keep their children healthy and smiling.

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