Contact Delta Dental Delta is here to help you with questions about your plan, coverage and for assistance finding a dental provider near you. Delta Dental DC 37 Customer Service Center (888) 523-DC37 (3237) Monday through Friday 8:00 am to 8:00 pm ET. Find a Dentist www.deltadentalins.com or call (888) 523-DC37 (3237) Monday through Friday. Delta Dental of Virginia 4818 Starkey Road, Roanoke, VA 24018 800.237.6060 DeltaDentalVA.com DELTA DENTAL TMPPO - EPO PLAN DESIGN – CP070 SCHEDULE OF BENEFITS AND COPAYMENT/COINSURANCE The benefits shown below are performed as deemed appropriate by the attending Dentist subject to the limitations and exclusions of the program.

Created with you in mind.

As the nation's leading dental benefits provider, we offer quality, cost-effective choices designed for you, your family and your well-being. And whichever plan you choose, top-quality customer service that makes you smile is our priority.

Please click on the name of a state to view plan information:

Affordable dental plans keep you smiling. There are probably a lot of things you'd rather do than go to the dentist. But your teeth and gums can be a gateway to good health. Delta Dental offers a choice of plans for adults and children. Click on the name of a state from the above list to view all individual and family plans available in your geography.

Traditional-Style Plans With Traditional-style Plans from Delta Dental, you get the same kind of dependable dental benefits offered by employee group plans. We're America's leading dental benefits company with plans that provide comprehensive, prevention-based dental insurance coverage to more than 60 million people nationwide.

In fact, many of your friends and family probably have Delta Dental insurance coverage. Protect your overall health through dental insurance coverage and regular dental check-ups.

All of these great benefits are now available to you through our traditional-style dental coverage:

- Dental Insurance coverage options for you and your family.

- Up to 100% coverage available on select dental plans for preventive services such as twice yearly exams and cleanings.

- Freedom to see any dentist you want in our extensive network.

- Competitive rates with automatic monthly payments.

- No waiting periods when transferring over from another qualifying group dental plan.

Paying out-of-pocket for something like a root canal or crown can cost hundreds or even thousands of dollars. You don't want to find yourself without quality dental coverage when a dental emergency comes up. Enroll in an individual plan today to get coverage for you and your family. Enrolling is easy...you can do it online and it takes just a few minutes.

Clear Plan* Protect your smile. Protect your wallet. Choose one of the newest dental plans around - that's competitively priced too!

The Clear Plan from Delta Dental is truly different! We listened to what consumers had to say, and designed the Clear Plan to take the confusion out of dental visits, once and for all. With the Clear Plan, you'll know, in advance, what your share of the cost for services will be. No worrying about percentages, deductibles, dollar maximums, or any other surprises.

Now you can get the quality dental benefits you need-easily!

- Choose coverage for yourself or your whole family.

- Dental coverage for implants, dentures, root canals and more.

- Predictable costs.

- Freedom to see any dentist you want in our extensive network.

- No deductibles, no annual dollar maximums, no waiting periods for benefits to begin.

*Clear Plan not available in all areas.

To provide you with details on the plans available in your zip code and for a custom quote please click on Get a Quoteto review your choices. No personal information is required to get a quote or review plans available in your zip code.

You may have heard about dental coverage available through Federal and State Health Marketplaces, as part of the Affordable Care Act. We encourage you to investigate these options by visiting the website of the Marketplace active in your state.

Contact Delta Dental
Delta is here to help you with questions about your plan, coverage and for assistance finding a dental provider near you.

Delta Dental
DC 37 Customer Service Center
(888) 523-DC37 (3237)
Monday through Friday
8:00 am to 8:00 pm ET

Find a Dentist
www.deltadentalins.com
or call (888) 523-DC37 (3237)
Monday through Friday
8:00 am to 8:00 pm ET

All About Your Plan
www.deltadentalins.com
List of Covered Dental Services
List of Excluded Dental Services
How to File a Claim with Delta Dental
Frequently Asked Questions (FAQS)

Delta Account Sign-In
Create a Delta Dental account to review your full benefits package online, check the balance remaining on your annual dental maximum, print a copy of your ID card, and sign up for paperless statements.
www.deltadentalins.com

Brooklyn Center
186 Joralemon Street
Brooklyn, New York 11201
(718) 852-1400
View Map

Manhattan Center*
115 Chambers Street
New York, New York 10007
(212) 766-4440
*Manhattan Center is closed for renovations until Spring 2021.
View Map

Welcome to the New DC 37 Health & Security Dental Benefit

Administered by Delta Dental effective September 1, 2020

With DC 37’s new Delta Dental Plan you now have access to more participating dentists
than ever before. Eligible DC 37 New York participants will find over 1,800 “New York Select Network” dentists to choose from with $0 copays and eligible DC 37 members residing outside New York now have thousands more participating “PPO Network” dentists nationwide to choose from with $0 copays.

How to Get Started

Visit www.deltadentalins.com to see benefits and find a participating dental provider. You can also sign up for your personal Delta Dental account to review your full benefits package online, check how much of your annual maximum benefit is left, print a copy of your ID card, and sign up for paperless statements. Help is also available via phone from DC 37’s dedicated Delta Dental Customer Service Center at 1 (888) 523-DC37 (3237), Monday through Friday, 8:00 am–8:00 pm ET.

Your Delta Dental Group Number for DC 37 is 20970.

How Do I Find a Participating Dental Provider in My Preferred Network?

(Delta Dental NY Select and Delta Dental PPO Networks)

If you live in New York, your Delta Dental network is the Delta Dental NY Select Network.

If you live outside of New York, your Delta Dental network is the Delta Dental PPO Network.

Use the Delta Dental provider search tool at www.deltadentalins.com to search for a dentist within the Delta Dental NY Select or Delta Dental PPO networks by area, language, and specialty.

Delta Dental customer service representatives are available to help Monday through Friday, 8:00 am to 8:00 pm (ET) at the Delta Dental DC 37 Customer Service Center for DC 37 members by calling 1 (888) 523-DC37 (3237).

Delta Dental Copay Schedule

Who Is Eligible for Coverage?

Eligible Full-Time Participants, retirees, and their covered dependents are covered for all covered dental services received from a Delta New York Select Network dentist (participants residing in New York) or a Delta Dental PPO Network dentist (participants residing outside New York) up to the $1,700 annual maximum per eligible participant. If a non-participating provider is used, full-time eligible participants will be responsible for any difference between the plan’s out-of-network allowance for dental services and the provider’s actual charges.

Eligible Part-Time Participants are covered 75% (with 25% coinsurance copay) for all covered dental services received from a Delta New York Select Network dentist (participants residing in New York State) or a Delta Dental PPO dentist (participants residing outside New York State) up to the $1,700 annual maximum per eligible participant. If a non-participating provider is used, part-time eligible participants will be responsible for any difference between the plan’s out-of-network allowance for dental services and the provider’s actual charges, in addition to the 25% coinsurance.

Please contact the toll-free Delta Dental Customer Service Center at (888) 523-DC37 (3237) to determine your eligibility for this benefit and your benefit plan allowances.

What Does My Plan Cover?

All previously covered dental services are provided under the new Delta Dental DC 37 Health & Security Plan effective September 1, 2020. You can view a printable PDF of benefits below, review your coverage at www.deltadentalins.com or call (888) 523-DC37 (3237) to speak with a Delta Dental Customer Service Representative for any questions about your coverage. In all circumstances, the plan’s rules regarding restrictions, limitations, and annual dollar limits will apply.

• List of Covered Dental Services under the DC 37 Health & Security Plan
• List of Excluded Dental Services/Coverage Exclusions under the DC 37 Health & Security Plan

Annual Dental Benefit Maximum

$1,700 per calendar year per participant (including eligible spouses, domestic partners and dependents). In all cases should you obtain treatment that is restricted, has a frequency limitation, is a non-covered procedure or service or if you go over the yearly maximum, you will be responsible for any additional costs incurred.

Orthodontia Lifetime Benefit

$1,840 lifetime maximum benefit per eligible participant (including eligible dependents). The start date is the date the appliance is inserted. At the time the appliance is inserted the plan pays up to 50% of the lifetime maximum. At the start of the second year of treatment the plan pays the remaining 50% of the orthodontic lifetime maximum. This is a change effective September 1, 2020. The orthodontia benefit is not covered in the part time dental benefit and available only to dependent children for retirees.

When Is Predetermination for a Service Needed?

Predetermination is mandatory before beginning treatment for prosthetics (dentures and bridgework), single crowns, extensive gum treatment, TMJ therapy, root canal therapy, or orthodontics. YOU MUST SUBMIT A PREDETERMINATION PLAN FOR THE ABOVE LISTED SERVICES OR YOUR CLAIM WILL BE REJECTED.

How Do I File a Claim?

You only have to file a claim in the instance you receive a dental service from a non-participating, out-of-network dental provider. If using any Delta Dental network provider, the provider is responsible for filing all claims for you. You have no responsibility for filing dental claim forms.

If you use a non-participating dental provider, you will be responsible for filing your own dental claims with Delta Dental. You must file such claims within one year (365 days) from the completion of the dental service. A claim filed after 365 days from the date of service will be rejected for timely filing.

How Do I Check a Claim Filed Prior to September 1, 2020?

Please contact the DC 37 Dental Unit at (212) 815-1600 for calls about dental claims that occurred before September 1, 2020.

Visit a DC 37 Dental Center

Eligible participants** are welcome to make an appointment for treatment at one of our DC 37 Dental Centers. The same plan restrictions, limitations, and benefit maximums apply.

Please familiarize yourself with our required Dental Center Rules and Policies before making an appointment. All DC 37 Dental Center patients must agree to comply with patient policies.

Brooklyn Center

186 Joralemon Street
Brooklyn, New York 11201
(718) 852-1400
View Map

Manhattan Center*

115 Chambers Street
New York, New York 10007
(212) 766-4440
View Map

*Please note, the Manhattan Center is closed for renovations and scheduled to reopen in Spring 2021.

Delta Dental Fee Schedule Pdf

**Active and retired members covered by the DC 37 New York Public Library Health and Security Plan Trust and the DC 37 Cultural Institutions Health and Security Plan Trust are not eligible for dental services at the DC 37 Dental Centers.

DISTRICT COUNCIL 37 HEALTH & SECURITY PLAN DENTAL BENEFIT DISCLAIMER
PLAN COVERAGE FOR ANY WORK PERFORMED BY YOUR DENTIST ASSUMES THAT YOU ARE ELIGIBLE FOR BENEFITS WHEN THE WORK IS PERFORMED AND TAKES INTO CONSIDERATION THE PLAN’S RULES AND REGULATIONS REGARDING ELIGIBILITY, YEARLY MAXIMUMS AND FREQUENCY LIMITATIONS FOR CERTAIN PROCEDURES.

You have the right to opt-out of the Plan’s dental benefit coverage. Please call (212) 815-1620 for more information.

Delta Dental Schedule Of Fees