Delta Dental of KY
Happy Smiles
- No waiting periods
- 100% coverage with no deductible for cleanings, exams, x-rays or sealants when visiting a Delta Dental PPO provider
- Enrollment available regardless of age
- Annual maximum increases to $750 in the second year; $1000 in the third year
- Prior carrier coverage may be considered to increase benefits
- White fillings are covered
- Bleaching is a covered benefit
This dental program allows members to utilize any licensed provider. Members who choose a Delta Dental PPO network provider have the lowest out of pocket expenses and cannot be balance billed.
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 10-50% |
| Crown: | No Coverage |
| Root Canals: | No Coverage |
| Simple Extractions: | 10-50% |
| Plan Maximum: | $500 – year 1, $750 – year 2, $1000 – year 3 (+) per contract year |
| Waiting Periods: | None |
| Deductible: | $50 per person per benefit year, $150 maximum per family. Applies to all services except diagnostic and preventive services |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine periodic examinations – two times in any 12 month period In-Network: 100% Out-of-Network: 80% Preventive – No waiting period | Cleanings: |
| Teeth Cleanings – twice in a calendar year In-Network: 100% Out-of-Network: 80% Preventive – No waiting period | X-Rays: |
| Bite-wing x-rays, one set in a 12 month period Full mouth x-rays, once within 3 years In-Network: 100% Out-of-Network: 80% Preventive – No waiting period | Fillings: |
| Restorative Amalgam Fillings, Resin-based composite (white fillings) – once per surface in a 24 month period In-Network: 1st year – 10% after deductible 2nd year – 30% after deductible 3rd year and after – 50% after deductible Out-of-Network: 1st year – 0% after deductible 2nd year – 25% after deductible 3rd year and after – 25% after deductible Basic – No waiting period | Extractions: |
| Simple Extractions and Oral Surgery In-Network: 1st year – 10% after deductible 2nd year – 30% after deductible 3rd year and after – 50% after deductible Out-of-Network: 1st year – 0% after deductible 2nd year – 25% after deductible 3rd year and after – 25% after deductible Basic – No waiting period | Crowns: |
| Not Covered Service | Root Canals: |
| Not Covered Service | Dentures: |
| Not Covered Service | Deep Cleanings: |
| Not Covered Service | Implants: |
| Not Covered Service | Braces/Orthodontia: |
| Not Covered Service | Teeth Whitening: |
| External bleaching procedures are covered once per 12 month period per arch; internal bleaching procedures are covered once per tooth per 12 month period In-Network: 1st year – 10% after deductible 2nd year – 30% after deductible 3rd year and after – 50% after deductible Out-of-Network: 1st year – 0% after deductible 2nd year – 25% after deductible 3rd year and after – 25% after deductible Basic – No waiting period | Additional Network Information: |
Please note: Dentists who have signed participating agreements with Delta Dental of Kentucky agree to accept the Allowable Amount as payment in full for Covered Services as these terms are defined in the Certificate of Coverage. Each Covered Person is responsible for the amount of Coinsurance, Deductible, and non-covered charges. Dentists who have not signed a participating agreement may bill you directly for any amount of their charge in excess of the Allowable Amount. In cases where the dentist’s charges exceed the Allowable Amount, your coinsurance will be larger. Certain procedures require pre-authorization and/or are subject to limitations. If you or your dependents have current dental coverage that has been in force a minimum of 12 months, you may be moved to the fully mature year two benefits. You will need to provide a certificate of credible coverage from your prior carrier (subject to review and approval by Delta Dental of KY) This is not a contract. It is a partial list of benefits and services. For complete details, refer to your certificate. Exclusions and LimitationsPrivacy Policy Plan Brochure |
FAQ:
Can I change my dentist once I am in the plan?
Yes, you may change your dentist at any time.
What is a pre-existing condition versus work-in-progress? Is it covered?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program. The plan does not cover any expenses prior to the date you are covered under the Policy.
What provider options do I have?
You have freedom to choose any dentist but visiting Delta Dental PPO dentist gives you great advantage of our negotiated rates with network dentists. The fees charged by in-network dentists are pre-establised by Delta Dental, meaning less out-of-pocket costs for you.
When can I start using my Plan?
Enjoy your benefits after your effective date. Applications submitted by the 25th of the month can become effective on the 1st of the following month. Any applications received after the 25th can become effective on the 1st of the second month.
Delta Dental Plans are a 12-month contract. NO COVERAGE changes allowed until the next open enrollment. NOTE: unless there is a qualifying event (proof required).
When will I receive my new member kit and what will it include?
You will receive your enrollment package upon completion of enrollment and payment of applicable premiums/enrollment fees, or a few days prior to the selected effective date. The enrollment package will include your Certificate of Coverage and I.D. cards and is sent via email from noreply@morganwhite.com.
Who can enroll in this plan?
Coverage is offered to Kentucky residents ONLY plus their eligible dependents (spouse or domestic partner and unmarried children from birth to the end of the benefit year in which they turn age 26). Coverage is offered to all ages. Child only enrollment is available option.
PO Box 242810
Louisville, KY 40224-2810
Disclaimers and Disclosures:
Delta Dental of Kentucky: Delta Dental of Kentucky offers exclusive dental options designed exclusively for individuals or families looking for coverage outside of their employers. Dental Plans are available to all Kentucky residents, regardless of age, income level or prior benefit coverage. Plans are a 12-month contract and offered to Kentucky residents only.
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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