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Dental

You and your eligible dependents will be covered under the UBT Dental Plan and the dentist you choose will determine your savings. The UBT Dental Plan covers diagnostic and preventative services at 100%, and no deductible is required. Out-of-pocket costs vary depending on the provider you choose.

You must meet the annual deductible of $25 per person, for class 2 and 3 services, before benefits are paid. Benefits will be paid up to the maximum annual benefit amount of $1500 per person per plan year.

See the plan booklet for additional information.

Options

  • Delta Preferred PPO providers offer the highest level of savings and cannot balance-bill you for the difference between the dental charge and the allowed amount. That means no additional out of pocket expenses.
  • Delta Premier providers are in the secondary network. While you receive a more modest savings compared to the PPO, you will have many more dentists to choose from than the PPO. You cannot be balance-billed for the difference between the dental charge and the allowed amount.
  • Non-participating providers will balance-bill you for any amount that exceeds Delta Dental’s allowed amount. They may ask you to pay the full amount up front and may have you submit your claim information to receive reimbursement.

Find a participating dentist

To find the names of participating dentists near you, call the Delta Dental’s customer service department toll-free at (877) 334-5008. The DASI (Delta’s Automated Service Inquiry) system is available 24 hours a day, seven days a week, and can provide you with the names of participating dentists. You can also go directly to www.deltadentaloh.com.

 

Filing a Claim

When using a non-network dentist, download a copy of the new Delta Dental claim form and print it before going to the dentist.Please review the instructions on the back (page 2) of the form before completing it. Mail completed form with original bill to:

Delta Dental
P.O. Box 9085
Farmington Hills, MI 48333-9085

Pre-Treatment Estimate

A pre-treatment estimate is recommended for services over $300. It outlines what the plan will pay, giving you an idea as to the portion of the cost that will be your responsibility. See the section on claims in the Plan Booklet.

Dental Reference Cards

A card is not required for service at your dental provider’s office. Simply give your State of Ohio User ID number at the time of service, and your provider will do the rest.

UBT heard your request for a simple, easy to use reference card to keep your benefit information on hand. You now have an option to print reference cards for you and your family’s dental visits. Visit Delta’s website, register and create a password, and print a card with your name and group number.

Downloads

Plan Booklet
Dental Claim Form
Coverage Comparison Chart