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Employers

Frequently Asked Questions

When can employees make changes to their dental plan? 

Changes can be made during the group’s open enrollment period or at the time of a qualifying event.
 

What are some qualifying events?

  • Marriage 
  • Divorce 
  • Death 
  • Birth of a child 
  • Loss of other health insurance coverage
 

How long can my employee be on COBRA?

An employee’s period of coverage depends on their qualifying event and their eligibility.
 
Qualifying Event Who is Eligible Period of Coverage
Employee termination Employee, spouse and dependents 18 months

Work hours reduced

Employee, spouse and dependents

18 months

Employee death

Surviving spouse and dependents

36 months

Employee divorce or legally separated

Divorced or legally separated spouse and dependents

36 months or the marriage of ex-spouse

Employee becomes eligible for Medicare

Spouse or dependents who are not eligible for Medicare

36 months

Dependent child older than age maximum

Dependent children who are older than the age maximum

36 months
 
For more information, download “An Employee’s Guide to Health Benefits Under COBRA
 

How do I know if my employee is eligible for a rollover maximum?

Specific criteria must be met to qualify. To learn more about their eligibility, employees should confirm your group’s benefits. For more information, download the Rollover Maximum Brochure
 

What happens if an employee is covered by more than one dental plan?

Delta Dental will coordinate coverage with the other carrier(s) to enable them to receive the maximum allowable benefit from each plan. This process, known as Coordination of Benefits (COB), allows reimbursement up to the total cost of the dental services. Employees should include all COB information on their enrollment forms.
 

If an employee has two separate dental plans, which one is primary?

In coordinating benefits, Delta Dental follows National Association of Insurance Commissioners (NAIC) guidelines. Rules are applied in the following order:
  • Capitated dental plans, such as DeltaCare, are always primary.
  • The primary carrier is the one that covers the employee as the enrollee (e.g., through their employer rather than their spouse’s employer). If they have two jobs, the plan that has covered them longer is primary.
     

Which is the primary dental plan for children with parents living together or married?

The primary carrier is determined by the “birthday rule.” Coverage of the parent whose birthday (month and day, not year) comes first in the year is the children’s primary coverage. For example, if the mother’s birthday is in April and the father’s birthday is in September, the mother’s plan is primary.  If both parents have the same birthday, the plan that has covered either parent longer is primary. 
 

Which is the primary dental plan for children whose parents are divorced, separated or not living together?

The plan that covers the parent with whom the child lives provides primary coverage. (In joint custody cases, the plan that has covered either parent/stepparent longer is primary). 
When a child is covered through remarriage or domestic partnership, coverage is determined in this order:
  • Primary: plan that covers the parent the child lives with
  • Second: plan that covers the custodial parent’s spouse or domestic partner
  • Third: plan that covers the other parent
  • Fourth: plan that covers the other parent’s spouse or domestic partner
 
If the above rules do not determine which plan is primary, coverage will be shared equally between plans. Finally, these rules are superseded by a court order establishing the person responsible for the child’s coverage.
 

How can I get a replacement card for an employee?  

Call 800-872-0500 or login to your online account.
 

How can I add/remove a member from our plan?

Log into your online account. If you don’t have a user id and password, call our online department at 877-453-8431. You can also submit an enrollment form by emailing enrollment@deltadentalma.com or by faxing your request to 617-886-1293.  

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