| Can I have group coverage too?||Yes||Yes||Yes
| Is there a child only plan?||No (19+ only)||Yes||Yes
| When will my credit card or |
bank account be charged?
|On or after 5th of month for current month||On or after 20th of the month for next month||On or after 20th of the month for next month
| Can I pay by check with|
| Is a check accepted by |
|Annual payment only||Monthly payment only||Monthly payment only
| When can I re-enroll if I |
term my plan?
|After 2 years unless moved to an employer sponsored group||After 2 years unless moved to an employer sponsored group||After 2 years unless moved to an employer sponsored group
| Is Smile Smart |
| Affordable Care Act Certified?||No||Yes||Yes
*The 502 Standard and 503 Enhanced plans meet the Affordable Care Act (ACA) requirements.
Delta Dental’s Smile Smart for Your Health program provides additional benefits for people with medical or dental risk factors like diabetes, pregnancy, cancer and more.
Frequently Asked Questions
How do I enroll?
You can enroll online by clicking here or download an application. Applications can be mailed to:
Delta Dental Individual and Family
Delta Dental of South Dakota
PO Box 1157
Pierre, SD 57501
Who is eligible to purchase an individual/family plan?
Delta Dental individual/family policies are available to residents of South Dakota. Coverage is also available for your spouse and/or dependent children.
What if I permanently move out of South Dakota?
Your coverage would terminate at the end of the month in which you changed residency. The plan is open to South Dakota residents only, which means that you must reside in South Dakota at least six months of the year.
Do I have coverage outside of South Dakota?
Yes, your Delta Dental coverage travels with you. Common examples are:
• A secondary residence outside of South Dakota
• Full-time students attending college in another state
• Traveling outside the state of South Dakota
What are my payment choices?
• For the Traditional (1040) plan you can pay monthly by credit card or electronic funds transfer. You can also pay by an annual check.
• For the Standard (502) and Enhanced (503) plans you can pay monthly by credit card, electronic funds transfer, or check.
When will the Electronic Funds Transfer (EFT) payment be withdrawn from my bank account?
• On or after the 5th of the month for the Traditional (1040) plan.
• On or after the 20th of the month for the Standard (502) or Enhanced (503) plans.
Will I receive a bill each month?
No, you will not receive a bill each month. You will receive an email each month notifying you that your credit card or bank account has been charged.
When will my dental policy be effective?
Your policy will be effective on the first day of the month following approval of your application.
How long are the rates guaranteed?
Rates are guaranteed through December 31. Thereafter, enrollees will receive a rate change notification by mid-November of each year for the following year’s rates.
Will my ID card show my dependent’s name?
No. It is common practice to show only the subscriber’s name on the identification card. Dental offices are familiar with this practice and will be able to confirm dependent benefits with the subscriber’s information.
How do I find participating dentists?
To find a participating dentist go to www.deltadentalsd.com and click on “Find a Dentist”. Then select the network "Delta Dental Premier" or “Delta Dental PPO”.
Can I go to any dentist I choose?
Yes, you may go to any dentist you choose however, to get the most from your benefits, choose a dentist who belongs to one of Delta Dental’s two dentist networks. Dentists in the Delta Dental PPO network offer significant fee reductions to Delta Dental patients. This minimizes out-of-pocket costs. Members can also choose a dentist from the Delta Dental Premier network. More than 98% of South Dakota dentists and more than three-fourths of dentists nationwide belong to this network. To locate a dentist in your area please use our find a dentist tool here.
What is my coverage year?
Your coverage year is the 12-month period (January – December) over which your deductible, maximums and other provisions apply.
Are there waiting periods before benefits are paid?
Yes, the individual plans have a one year wait for coverage for endodontics (root canals), periodontics (gum and bone diseases) and major services like crowns, bridges, dentures and implants. On the Standard (502) and Enhanced (503) plans the waiting period does not apply to children under 19.
What is a waiting period?
A waiting period is the period of time during which a subscriber must wait before starting to receive benefits.
If I have been covered on a dental plan for at least the last 12 consecutive months and have no break in coverage, would the waiting periods be waived?
Yes. Whether you were the primary subscriber or a covered dependent, waiting periods will be waived for the covered individuals.
What is a deductible?
A deductible is the amount enrollees must pay toward treatment before their dental benefits are paid. The deductible, plus co-insurance and any amount over the annual maximum is often referred to as the enrollee’s out-of-pocket costs. The deductible applies to each person enrolled in your plan.
Is the annual maximum an individual or a family maximum?
The maximum is for each person enrolled in the dental plan.
Are there services that are not covered?
Yes, see the Exclusions section.
Is treatment for a missing tooth immediately covered?
If you lose a tooth through accident or injury, you are immediately covered for emergency treatment to relieve pain. However, for replacement of teeth that have been missing for some time through the use of bridges or dentures there is a one year waiting period.
Are periodontal maintenance cleanings covered?
If you have a history of periodontal services and have satisfied the one year periodontal waiting period, periodontal maintenance is covered. You can receive two periodontal maintenance services, or two routine cleanings or one of each, but you cannot receive more than two services total during your coverage year. If you qualify under Delta Dental’s Smile Smart program, you may be eligible for additional services (Traditional (1040) plan only).
Are sealants covered on all teeth?
Dental sealants are a benefit once in a lifetime for unrestored first and second permanent molars of children up to age 16.
What kinds of fillings are covered?
Fillings consist of two different types: a silver material called amalgam, or a tooth-colored material called composite. If you need fillings on back (posterior) teeth, only silver fillings are covered. If you choose to have your dentist use the tooth-colored material, you will have to pay the difference in cost. Fillings are a benefit once for each tooth surface in a 24 month interval from the date the service was last performed on that specific tooth surface.
Are implants covered?
Yes, after a one year waiting period.
Are cosmetic procedures like bleaching covered?
Cosmetic procedures are not a covered benefit.
Are services such as relines covered on dentures I received prior to having this plan?
Yes, but waiting periods and limitations may apply.
What is Smile Smart for Your Health?
If you or someone on your dental policy has any of the following health conditions, you/they are eligible for additional benefits (per coverage year) through our Smile Smart for Your Health program. Smile Smart is not a benefit on the Standard (502) and Enhanced (503) plans.
• Gum (periodontal) disease (4 cleanings*, 2 applications of fluoride varnish)
• Diabetes (4 cleanings*)
• Pregnancy (1 additional cleaning during the time of pregnancy)
• High-risk cardiac conditions (4 cleanings*)
• Kidney failure or undergoing dialysis (4 cleanings*)
• Undergoing cancer-related chemotherapy and/or radiation (4 cleanings*, 2 applications of fluoride varnish)
• Suppressed immune systems (4 cleanings*, 2 applications of fluoride varnish)
• At risk for oral cancer (brush biopsy test for early detection of oral cancer/precancerous cells)
*Cleanings can either be a general (prophylaxis) cleaning or a periodontal maintenance cleaning except where noted. Periodontal maintenance cleanings are covered under the “Endodontics and Periodontics” category, not the “Diagnostic and Preventive Services” category. Your dentist may or may not charge for exams related to added periodontal maintenance or cleanings. The additional exams are not covered.
What does “medically necessary only” mean regarding wisdom teeth and orthodontics on the Standard (502) and Enhanced (503) plans?
Medically necessary is an extremely rare circumstance as determined by a third party dental consultant and in all cases requires a preauthorization.
• The removal (extraction) of wisdom teeth (third molars) must meet the medically necessary requirements in order to be a benefit. The medically necessary requirements are: Surgical removal of impacted third molars is limited to patients with evidence of pathology. This includes, but not limited to, unrestorable caries, non-treatable pulpal and or periapical pathology, cellulitis, abscess, resorption of tooth or adjacent teeth, fractured tooth, teeth that involve cyst/tumors or teeth involving reconstructive surgeries. Your provider must send a predetermination of benefits to Delta Dental.
• Medically necessary orthodontic services are related to and an integral part of the medical and surgical correction of a functional impairment resulting from a congenital defect or anomaly, such as but not limited to, the correction of a congenital defect like cleft palate, etc. Your provider must send a predetermination of benefits to Delta Dental.
What is the out-of-pocket maximum on the Standard (502) and Enhanced (503) plans?
Once you have spent $350 per child or $700 for two or more children in a coverage year all covered services will be covered at 100%. The out-of-pocket maximum is made up of deductibles and co-insurance. If you see a non-participating dentist, the difference between what they charge and what Delta Dental allows will not apply to the out-of-pocket maximum. The out-of-pocket maximum only applies to children up to age 19.
The following exclusions are not benefits.
You are not covered for restorations or procedures due to allergies or allergic reaction to dental treatment materials such as allergies to metals or mercury.
Anesthesia or analgesia
You are not covered for local anesthesia or nitrous oxide (relative analgesia) when billed separately from the related procedure. This exclusion does not apply to general anesthesia or intravenous sedation administered in connection with covered oral surgery.
Appliances, restorations, or procedures for:
• increasing vertical dimension;
• restoring occlusion;
• correcting harmful habits;
• replacing tooth structure lost by attrition, abrasion, erosion and abfractions;
• correcting congenital or developmental malformations;
• temporary dental procedures;
• splints, unless necessary as a result of accidental injury;
Athletic mouth guards
You are not covered for the construction or repair of any athletic mouth guard.
Broken or missed appointments
You are not covered for any charges for failure to keep a scheduled visit with your dental provider.
Cleaning of prosthetic appliance
Your plan does not cover the cost of cleaning removable partials or dentures.
Completion of form
Your plan does not cover any charges to complete forms.
Complete occlusal adjustment
You are not covered for services or supplies used for revision or alteration of the functional relationships between upper and lower teeth.
Complications of a non-covered procedure
You are not covered for complications of a non-covered procedure.
The charge for a practitioner’s opinion or advice given in-person, by phone or other electronic means is not a covered service.
Controlled release device (antimicrobial agents)
The use of localized delivery of antimicrobial agents as part of the overall management of periodontal disease is not a covered benefit.
Correction of occlusion
You are not covered for the correction of occlusion when performed with prosthetics and restorations involving occlusal surfaces.
Cosmetic in nature
You are not covered for services or supplies which have the primary purpose of improving the appearance of your teeth, rather than restoring or improving dental form or function or the treatment of dental disease.
Crowns not meant to restore form and function
You are not covered for crowns that are not meant to restore form and function of a tooth, including crowns placed for the primary purpose of periodontal splinting, cosmetics, altering vertical dimension, restoring your bite (occlusion), or restoring a tooth due to allergies, wear, (attrition, abrasion, erosion and abfractions). Crowns placed on anterior teeth for endodontic purposes only are not a benefit. Crowns placed prior to actual failure of the tooth is not a benefit. Crowns placed for fracture lines (craze lines) are not a benefit.
• Provided by other than a dentist or licensed hygienist employed by a dentist.
• To treat injuries or diseases caused by riots or any form of civil disobedience.
• To treat injuries sustained while committing a criminal act.
• To treat injuries intentionally inflicted.
• In cases for which, in the professional judgment of the attending dentist, a satisfactory result cannot be obtained.
You are not covered for desensitization materials or their application.
You are not covered for prescription, non-prescription drugs, medicines or therapeutic drug injections.
Your plan does not cover any charges for the duplication of dentures.
Duplication of dental records
Your plan does not cover any charges for the duplication of dental records.
You are not covered for services or supplies received before the effective date of coverage.
Experimental or investigative
You are not covered for services or supplies that are considered experimental, investigative or have a poor prognosis. Peer reviewed outcomes data from clinical trial, Food and Drug Administration regulatory status, and established governmental and professional guidelines will be used in this determination.
You are not covered for services or supplies when you are entitled to claim benefits from governmental programs (except Medicaid).
Health or medical plan
Services for which a benefit is provided by a health or medical plan.
You are not covered for dental services that have not been completed.
You are not covered for separate charges for “infection control,” which includes the costs for services and supplies associated with sterilization procedures. Participating dentists incorporate these costs into their normal fees and will not charge an additional fee for “infection control.”
Lost or stolen appliances
You are not covered for services or supplies required to replace a lost or stolen dental appliance or charges for duplicate dentures.
Medical services or supplies
You are not covered for services or supplies which are medical in nature or covered under a medical plan. These may include but are not limited to dental services performed in a hospital, surgical treatment centers, treatment of fractures and dislocations, treatment of cysts and malignancies, and accidental injuries or treatment rendered other than by a licensed dentist.
You are not covered for services or supplies received while you are on active status in the military services.
Night guard/occlusal guards
Your plan does not cover appliances for bruxism, grinding or clenching of teeth.
Non-standard dental treatment and procedures
There is no coverage for services or supplies, as determined by Delta Dental, which are not provided in accordance with generally accepted standards of dental practice.
Orthodontic appliances repair or replacement
Your plan does not cover repair or replacement of any orthodontic appliance.
You are not covered for services or supplies when someone else has the legal obligation to pay for your care.
You are not covered for services or supplies for periodontal appliances (bite guards) to reduce bite (occlusal) trauma due to tooth grinding or jaw clenching.
You are not covered for services or supplies used for the primary purpose of reducing tooth mobility, including but not limited to crown/bridge restorations.
Prevention control programs
Preventive control programs including but not limited to oral hygiene instructions, caries susceptibility tests, dietary control, tobacco counseling, and home care medicaments are not a covered benefit.
Provisional (temporary) crowns, bridges, dentures, partials or implants
You are not covered for services or supplies for provisional (temporary) crowns, bridges, dentures, partials or implants.
Pulp caps (Direct or Indirect)
You are not covered for any pulp cap procedures.
Sealants for primary teeth, wisdom teeth, or restored teeth
You are not covered for sealants for primary teeth, wisdom teeth, or teeth that have already been treated with an occlusal restoration. Coverage only applies to 1st and 2nd permanent molars, non-decayed, non-restored up to age 16. This is a once in a lifetime benefit per eligible tooth.
Services provided in other than an office setting
You are not covered for services provided in other than a dental office setting. This includes, but is not limited to, any hospital or surgical/treatment facility.
You are not covered for specialized, personalized, elective materials and techniques or technology which are not reasonably necessary for the diagnosis or treatment of dental disease or dysfunction. Specialized services represent enhancements to other services and are considered optional. Includes, but not limited to, copings and precision attachments.
Provider tax, state sales tax, or medical tax is not a covered benefit.
Temporary or interim procedures
You are not covered for temporary or interim procedures.
Temporomandibular joint (TMJ) dysfunction
You are not covered for expenses incurred for diagnostic x-rays, appliances, restorations or surgery in connection with temporomandibular joint (TMJ) dysfunction or myofunctional therapy.
Whether or not we have approved a treatment plan, you are not covered for treatment received after your termination date.
Tooth colored fillings
Composite/resin restorations are allowed on the front teeth (anterior teeth) only. When composite/resin restorations are done on the back teeth (posterior teeth) they are considered optional services. Coverage will be made for a corresponding silver (amalgam) restoration.
Treatment by other than a licensed dentist
You are not covered for services or treatment performed by anyone other than a licensed dentist or a licensed hygienist employed by the dentist.
You are not covered for any service started during a waiting period.