Frequently Asked Questions:

Group number: 

Enhanced plan:  9392-0002

Base plan:  9392-0001 

1.   Where can I check on the status of a claim?

• visit www.deltadentalar.com , click the “Subscriber” option then select “claims”.
• call customer service at 1-800-462-5410.

2.  How can I get a new ID card?

• call the Delta Dental Marketing Department at 501-992-1883
• contact the UCA Human Resources office at 501-450-3181 

3.  Can I use any dentist?

• You have the freedom to choose any dentist to provide your services.  Furthermore, Delta Dental of Arkansas has two networks, Delta Dental Premier and Delta Dental PPO.

 

• If your dentist participates in one of the Delta Dental networks mentioned above, the dentist has agreed to file your claim for covered services.  They agree to accept allowable fees and not charge you more than that amount.  You are still responsible for your deductible, coinsurance and ineligible services.  Payments for services by your dental plan are made directly to the participating dentist.

 

• If your dentist doesn’t participate with Delta Dental of Arkansas, you may be required to file your claim form.  All non-participating dentist claims payments will be made directly to you.  Since non-participating dentists are not obligated to accept Delta Dental’s negotiated allowable fees, you may owe the difference between the amount billed and Delta Dental’ s allowed amount.  You will need to make payment directly to the dentist.

 

4.  If my dentist participates with Delta Dental of Arkansas, does it matter to me which network they are in?

• Whether you are on the “base” or the “enhanced” plan, you are allowed to use dentists from either of the two networks.  There is no penalty for using one network over the other.  However, due to contract discounts Delta Dental has with the different networks, your out-of-pocket expense could be slightly higher for dentists in the Premier network.

5.  How can I determine if a dentist is in the network?

• visit website at www.deltadentalar.com
• call customer service at 1-800-462-5410
• use provider directory
• ask the dentist

6.  What is a deductible?

• This is the amount of money that must be paid each calendar year by the member prior to Delta Dental of Arkansas assuming liability for services requiring a deductible. 

7.  How much is the deductible?

• The deductible for the University of Central Arkansas dental plan is $50 per calendar year per person. 

8.  What is the family deductible?

• Each person in the family must meet the $50 calendar year deductible. 

9.  What is the annual maximum?

• The University of Central Arkansas plan has a $1,000 “annual maximum” for covered services excluding orthodontia.

10.  What is a Pre-Determination?

• PRE-DETERMINATION is an opinion from DDAR as to payments that would be made by DDAR as reasonably necessary for anticipated treatment of a participant.  The opinion is based upon information forwarded to DDAR. It does not guarantee such payment in that actual payment would also depend on applicable coverage being in effect at the time any such services were rendered.  The payment may also be subject to deductible, co-insurance, and maximum benefits allowed. Similar terms also used for pre-determination are pre-authorization, prior-authorization, pre-treatment review, and/or, pre-certification. A participant, however, is not required to seek a pre-determination for any treatment under this plan.

11.  Is a Pre-Determination required prior to services being rendered?

• A pre-determination is not required, but is suggested when services are expected to exceed $300. 

12.  How often can I go to the dentist for my cleaning?

• Cleanings are covered under your plan twice in any benefit period.  A benefit period is defined as a calendar year. 
• There is no time limitation between the services. 

13.  Are adults covered for orthodontic procedures?

• Adults are not covered for orthodontic procedures. 

14.  What is the orthodontic maximum?

• The University of Central Arkansas allows for a “lifetime maximum” of $1,000 for orthodontic services for dependent children.

15.  As a new employee, when is my dental insurance coverage effective?

• Your dental insurance under the “base” plan will become effective on the first day of the month following completion of ninety days. 

16.  As a new employee, when am I eligible for the “enhanced” plan?

• New employees are eligible to move from the “base” plan to the “enhanced” plan after being covered under the “base” plan for one year. 

Note:  Written request is required from employee before transferring employee’s coverage from “base” to “enhanced”.

17.   I did not move to the enhanced plan when I first became eligible.  When is my next opportunity?

• If you did not join the enhanced plan when you first become eligible, you can make the move at the next annual enrollment period. 

18.  Is orthodontia covered on the “base” plan?

• No.  Orthodontia is covered only under the “enhanced” plan.  The teeth must be banded after the “enhanced” plan is effective.  If the teeth are banded while covered on the “base” plan or while under another dental plan, the orthodontia charges incurred under the “enhanced” plan will be denied.

19.  My child is a full-time student out-of-state.  Does my child have dental coverage?

• Yes.  Delta Dental has contracted dentists in every state in the USA.  You and your family members have access to any Delta Dental Premier or Delta Dental PPO dentist nationwide.  Network dentists can be found by accessing our website at www.deltadentalar.com and choosing the Subscriber Tab on the left side of the screen and then the Find a Dentist option.  You can choose from either network listed above.    

20.  When can I add/delete a family member to/from my policy? 

• Initial Plan Enrollment:  Eligible dependents must enroll for coverage within thirty-one (31) days from their eligibility date under the contract.  If they do not enroll for coverage within that time frame, they may only enroll during the Annual Enrollment Period or with an Enrollment Qualifying Event. 
• Annual Enrollment Period: Eligible employees and/or dependents that do not enroll for coverage on a timely basis upon initial eligibility or with an enrollment qualifying event will be permitted to enroll for coverage during the annual enrollment period.  Likewise, during the annual enrollment period, eligible employees and/or dependents may be deleted from the plan. 

• Qualifying Event:  Eligible employees and/or dependents may be added or deleted within thirty-one (31) days of an Enrollment Qualifying Event .  (see next question for definition)
• Dependent - Age 19:  Dependents reaching age 19 and not enrolled full-time at an accredited college or university will lose coverage as of the last day of the calendar month, unless the individual elects continuation of coverage through COBRA. 
• Dependent – Age 23:  The dental plan only allows coverage of dependents enrolled full-time at an accredited college or university until age 23.  The coverage will end on the last day of their birthday month unless the individual elects continuation of coverage through COBRA.

21.  What is a “qualifying event”?

• Family changes:  marriage, divorce, birth, death, adoption, or placement for adoption, or
• Job changes:  when dependent loses or gains coverage under another group dental plan.

• Please call the UCA Human Resource office at 450-3181 if you are unsure if your situation qualifies.

22.  Must I add my newborn child to the dental plan at birth?

• Dependent children can be added to the plan at anytime prior to their 3rd birthday.  After that time, the standard requirements are applied. 

23.  When does my child become ineligible for coverage?

• Dependent children are covered through the end of the month in which he/she turns nineteen (19). 
• A dependent child between ages 19 and 23 who is a full-time student at an accredited college or university will continue to be an eligible dependent until the end of the month that the child turns age twenty-three (23). 

School vacation periods during any school year (September-August) which interrupt but do not terminate what otherwise would have been a continuous course of study shall be considered part of school attendance on a full-time student basis.

24.  How will Delta Dental know if my dependent, between ages 19 and 23, is a full-time student? 

• Ninety days prior to your dependent’s 19th  birthday, Delta Dental will send a letter to the employee’s home address.  This letter requests written proof of the student’s full-time student status.  A follow-up letter is sent again 30 days prior to the child’s birthday if the information has not been received.  Full-time student verification runs from September 1 - August 31.  Each year Delta Dental will send a letter to all parents of dependents with full-time student status the previous year.  The letter requests an update of student status by submitting written proof of the student’s continued full-time student status.   

25.   My child was in braces when UCA changed to Delta Dental of Arkansas.  Does my child get another      orthodontic maximum benefit? 

• Delta Dental of Arkansas will be provided with a listing of dependents and the amount of the maximums that have been incurred thus far.  Any payments that have already been made will be applied to the Lifetime Maximum Benefit and any remaining benefit will be allowed.  All dependents that were covered under the benefit plan on the day prior to 1/1/07 who are currently in treatment will not be subject to the “pre-existing condition” for orthodontic payments.  Any new participants to the plan who are already  “banded” will be subject to the “pre-existing condition” clause and will not be covered. 

26.  I am also covered on my spouse’s dental plan.  How will the two plans work together?

• The program covering the patient as an EMPLOYEE is “primary” over a program covering the patient as a DEPENDENT.  Therefore, in this case, the UCA plan will be “primary” and the other plan will be “secondary”.

27.  My children on are covered under two dental insurance plans, the mother’s and the father’s.  Which plan is primary?

• The coverage of the parent whose date of birth occurs earlier in the CALENDAR year will be “primary”. 
• Except for a dependent child of legally separated or divorced parents, the coverage of the parent with legal custody, or the coverage of the custodial parent’s spouse (i.e. stepparent) will be primary.