Delta Dental Orthodontic Services

Proper tooth alignment is important not only for a beautiful smile, but also for function. When teeth are aligned, it’s easier to chew and talk. And it’s also important to correct and guide tooth and jaw development as a child grows, to ensure a healthy and functioning smile for adulthood.

• What are Orthodontic Services?

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  Orthodontic services, often referred to as “ortho,” are services, treatment and procedures used to correct misaligned teeth. These services can include braces, retainers, and other orthodontic appliances.

• Who is eligible for orthodontic services?

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  Dependent children up to the age of 19 are eligible.

• How much is covered by the plan?

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  Orthodontic services include a lifetime maximum benefit of $1,500 per eligible dependent. There is no deductible for orthodontic services.

• Do I need a referral to visit an orthodontist?

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  No referral is necessary to visit an orthodontist. To find a participating Anthem orthodontist, go to www.anthem.com or call their Customer Service Department at 1-877-604-2142

• How will orthodontic services be paid?

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  Anthem requires your dentist to submit an orthodontic treatment plan. When orthodontic treatment starts, Anthem will pay a percentage of the total fee. They will continue to make payments based on the type of treatment or until the lifetime orthodontic maximum is reached. Payments will be made quarterly.

• How are my current and historical orthodontia benefits impacted?

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  The lifetime maximum amount of 50% up to $1500 for orthodontia coverage for dependents up to age 19. If you are currently in treatment for orthodontia services and have not yet met the lifetime maximum allowed amount you will be eligible for the remaining balance under the Anthem plan. If you have already met the ortho maximum, you will not be newly eligible under the Anthem plan. For more information on specifics of orthodontia coverage view this resource.

• What if ortho treatment has already begun under a different carrier?

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  If your child is in the middle of an active orthodontic treatment, like having bands placed, Anthem will need you or your orthodontist to mail a copy of the original orthodontia claim to the address listed on the back of your ID card.  It should include

  • treatment type (procedure number)
  • total fee for the treatment
  • number of months treatment will take place
  • the orthodontist’s signature. 

  The amount Anthem will pay is based on the number of months of active treatment you have left.  Anthem will subtract the amount you’ve already paid, then divide what you still owe by the number of months left in the treatment.

• If my child turns 19 while undergoing treatment, will my benefits continue?

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  Yes, if the child has been banded prior to age 19.

• How can I find out what is covered under my plan?

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  For more information on what’s covered by the plan, please refer to the Summary of Dental Plan Benefits and Certificate. (will have this to attach later. Will need to update copy.)