Individual and Family (I&F) Producer FAQ

Step 1: Use the URL to navigate to DeltaDentalCoversMe.com. The URL will display in your browser’s address bar. Enter zip code, date of birth and coverage start date. This is also the first step in the enrollment process.

Note: The URL is unique for your agency. All participating brokers at your agency share the same URL.

Steps 2-4: Your agency name displays after step 2. The client selects your name from the drop-down menu in step 2, then your name and contact information displays throught quote and enrollment.

Here are screen shots:

Step 1: Enter zip code and coverage start date

Step 2: Select your producer name (all I&F producers in your agency are displayed)

Step 3: Review and select Dental and Vision plans. Vision cannot be selected without dental.

Step 4: Your client enters required information to complete enrollment

You will receive weekly emails with a list of all policies sold using your URL the prior week. You can also review your book of business using the broker portal feature at www.DeltaDentalCoversMyClient.com.

When a member is enrolled online, they opt in to receiving electronic documents – all enrollment documents are supplied at the end of the enrollment. If the member includes an email address when entering in their personal detail, a welcome email will be delivered.

If the unique URL isn’t used, contact Wyssta producer support at 844-335-8275 or welovebrokers@deltadentalcoversme.com to have the account assigned to you. You will need the client’s name and DOB to be assigned as broker of record. You can also request in broker portal.

Issues can be reported to producersupport@deltadentalwa.com

Digital brochures have been created for you to share with clients. Digital brochures are available through the broker resource page at deltadentalwa.com.

Yes. Refer your clients to the producer phone sales number 877-943-8335. The service representative will ask the client for the name of the referring producer and will assign the account for servicing and commission.

Mail the completed application and physical check to Delta Dental Billing and Enrollment PO Box 103 Stevens Point, WI 54481. Or, fax to 1-800-807-1970. Paper applications can be downloaded from DeltaDentalCoversMe.com and the Producer Resource Page on DeltaDentalWA.com.

Client ID numbers are in the weekly production report emailed following a sale. The ID number is also listed on your commission statements. You can also get your client's ID in the broker portal.

New customers can add vision coverage at the time they enroll for dental. Current dental plan subscribers can add optional Vision coverage on the 1st of any month. Adding Vision is done easily by phone at 888-899-3736. Alternatively, you can submit a paper application. Online enrollment is not available for adding Vision.

Yes, Dental and Vision plans must have the same household members.

No. The Vision ID number is unique. The Vision ID number will be shown on the policy declaration page.

DeltaVision uses the VSP Choice network, plus access to multiple retailers, including Costco, Pearle Vision and Walmart. Note: Benefits are valid at Costco and Walmart warehouse locations only. Costco.com and Walmart.com are out-of-network.

Participating Providers can be found at VSP.com or by calling VSP at 800-877-7195. Once enrolled, encourage your clients to activate a VSP web account and use the search feature from their account portal. This is the easiest, most reliable way to view all the network providers for your client's plan.

No. Services and products from out-of-network providers are not covered.

Advise your clients to visit VSP.com and select the Log in / create an account link at the top of the home page. Follow the prompts to set up the new account, using the ID number provided on the declaration page of the new Vision policy.

If you have questions prior to enrollment on a vision plan, please call Delta Dental Covers Me at 877-943-8335. Once enrolled, for questions about claims, have your client contact VSP at 800-877-7195.

Payment methods available through DeltaDentalCoversMe.com are: credit or debit cards (Visa, MasterCard or Discover) or bank draft/electronic funds transfer (EFT). Checks are not accepted for sales made using your URL.

Monthly, semi-annual, and annual.

Yes, clients submitting paper applications can submit a paper check for annual premium only. If your client would like a different payment frequency, they must choose a different payment method.

When sold using your URL, your client can request an effective date up to 2 months in the future.

Example: You submit your client’s application online on December 12. Your client can select an effective date of January 1 or February 1.

When sold using a paper application, your client will receive an effective date of the first of the month following approval of their application.

Example: You mail a paper application that is processed on December 12. Your client will receive an effective date of January 1.

Credit/debit card applications must be received by the last business day of the month for an effective date of the first of the next month. When paying with bank draft/EFT, applications must be received by the 24th of the current month or the business day prior if the 24th is not a business day. If the application is received after the 24th, the plan will have an effective date of the 1st of the following month. This applies to applications submitted through your URL or via paper.

Example: An application received on the 27th of June with bank draft as the payment method will have an effective date of August 1st. That same application with credit card as the payment method can have either a July 1 or August 1 effective date depending on the applicant preference.

All plans are 12-month contracts.

In most cases, members cannot leave their plan mid-contract. When they purchase a plan, members are agreeing to keep the plan for at least 12 months. However, there are 3 reasons why a member can leave their plan mid-contract:

1. They become covered under a group plan at work,
2. The policyholder passed away, or
3. They enter into military service.

Yes, they can call our sales team at 888-899-3736. Or, they can submit a paper application. A paper application can be printed from DeltaDentalCoversMe.com or downloaded from the Producer Resource Page.

• If using a paper application, it must be accompanied by a written cancellation request for the current policy.
• Include your producer information in the section at the bottom of the application.
• Email to customersupport@deltadentalcoversme.com, or
• Fax to 1-800-807-1970, or
• Mail to Delta Dental Billing and Enrollment PO Box 103 Stevens Point, WI 54481.

We can terminate a plan mid-contract for one of the following reasons:

1. Failure to pay premium,
2. A person covered by the policy commits fraud related to the policy, or
3. A person not covered by the policy uses the policy.

Certain policies have a 12-month Waiting Period that applies to certain covered procedures. This means that Delta Dental of Washington will not pay towards any of these procedures until the patient has been enrolled in this Policy for 12 continuous months. Please see the “Benefits” section of the specific policy document for procedures that are subject to the Waiting Period.

If the patient was covered under a comparable full-coverage dental plan that included Major services, for at least 12 continuous months before enrolling in this Plan, any Waiting Periods will be waived—provided there was no more than a 63-day gap between their previous coverage and this Policy. Dental services obtained through a discount plan do not qualify as comparable coverage and will not count toward satisfying the Waiting Period requirement.

When the patient enrolls, they will be asked to provide information about their previous plans to make sure they qualify for a Waiting Period waiver. Waiting Periods will not be waived for new members added to this Policy without prior qualifying coverage, or if there was more than a 63-day gap between any of their previous Policies and the effective date of this Policy.

Except for Washington Health Benefit Exchange pediatric medically necessary orthodontics, a pretreatment estimate is not required for any service but will provide the patient with general coverage information regarding your benefits before treatment begins.

Coverage percentages are based on allowed amounts, after any deductibles are paid. For example, if the coverage percentage listed is “80 percent,” Delta Dental of Washington will pay 80 percent of the amount Delta Dental of Washington allows, after any deductibles are paid. In this case, the patient must pay the remaining 20 percent, which is the coinsurance.

The annual maximum, also known as a plan year maximum, is the most Delta Dental of Washington will pay for covered care in a year. After a patient meets that amount, they will need to pay for any other dental services themself until their benefits reset.

For the Ascent Plan only, the annual maximum starts at $1,000 per person. If a patient remains in the same policy for a second year, the annual maximum increases to $1,250 per person. If they renew the policy for a third consecutive year, the annual maximum increases to $1,500 per person.

The Plus Ortho plan covers orthodontic care for kids and adults including braces, aligners, or clear aligners installed by a DMD or DDS. This plan additionally covers athletic mouthguards once every three years, for children ages 6 through 18.

If a patient misses a payment, we will put a hold on paying their claims starting on the first day of the month after their missed payment. Payment for their claims will stay on hold until their account is paid. After 30 days, we may end this policy, and anyone covered under this policy may lose coverage.

Plans are reviewed and filed on a yearly basis which may include changes to plan benefits. In special circumstances, plans may be closed to new sales off cycle.

I&F plans are created based on customer value and dental market demand to meet a variety of patient needs.

Yes, we recommend that you refer clients to our Interactive Plan Finder which asks a short series of questions about their dental health and benefit preferences to identify which plan may be right for them. Note that the plan finder only includes recommendations for Individual and Family plans and not Washington Health Benefit Exchange plans.

Yes, you can find downloadable and printable brochures located on our site here: https://www.deltadentalwa.com/Individual-family-resources/individual-and-family-brochures.

They should call customer service at 888-899-3734 or email CustomerSupport@DeltaDentalCoversMe.com.

You should call I&F producer service at 844-335-8275 or email welovebrokers@deltadentalcoversme.com.

If you have completed and returned your producer appointment paperwork or work for a brokerage house that has, you are able to receive new sales commissions on policies. After you have received an email with your DeltaDentalCoversMe.com URL, you may begin selling Individual and Family plans.

The new sales and renewal commission on premium earned is 5% for dental and 10% for Vision.

Commissions are paid the month after premiums are received and will be included on the same check as commissions for any group business you have with us.

Example: A plan sold in November with a January 1 effective date will have commissions paid the month after premiums are received.

No, you will not receive a notification.

Yes, a 5% commission is paid on Delta Dental plans sold on the Washington Health Benefit Exchange.

If you have completed and returned your producer appointment paperwork or work for a brokerage house that has, you are able to receive new sales commissions on policies. After you have received an email with your DeltaDentalCoversMe.com URL, you may begin selling Individual and Family plans.

The new sales and renewal commission on premium earned is 5% for dental and 10% for Vision.

Commissions are paid the month after premiums are received and will be included on the same check as commissions for any group business you have with us.

Example: A plan sold in November with a January 1 effective date:

	November	December	January	February	March	April
Premium Paid	For January		For February	For March	For April	For May
Commission Paid		For January		For February	For March	For April

No, you will not receive a notification.

Yes, a 5% commission is paid on Delta Dental plans sold on the Washington Health Benefit Exchange.

The DeltaDentalCoversMe (DDCM) portal provides you with the information you need to support your Delta Dental of Washington Individual & Family plan clients. The portal is secure and can be accessed on mobile devices as well as on your computer. Use Google Chrome as your web browser for best results.

You have access to your book of business and client policy information:

• View your active and terminated policies
• View your clients’ billing history
• Download and print ID cards and other policy documents
• Find your personal URL

You can service your accounts 24/7:

• Update premium payment methods
• Make a payment
• Update client contact information
• Submit plan changes and terminations

Accessing the portal is easy:

Step One: Get set up in our system

We need your NPN number for portal access. Please email your NPN information to Individualplans@deltadentalwa.com. In approximately 10 days you will receive a welcome email with a link to set your password.

Step Two: Enter your credentials into the portal

Log into the portal at www.DeltaDentalCoversMyClient.com and enter the login credentials received in your welcome email.

Call or email producer service at 844-335-8275 or welovebrokers@deltadentalcoversme.com.