Delta Dental Plans
Payment and Claims Information
If you visit an out-of-network dentist, you may be responsible for paying for your treatment at the time of service. To request reimbursement:
1) Obtain a detailed receipt, including:
- Dentist's name and address (including city/country)
- Services performed
- List of teeth treated
- Currency of payment (such as U.S. dollars)
2) Submit a claim to Delta Dental to request reimbursement of covered treatments:
- Download and print a claim form at: deltadentalins.com/enrollees
- Submit your form and detailed receipt (see above)
- If records or receipts are not in English, translate as much as possible into English, or provide an English patient statement
- Include your current address and phone number so Delta Dental can reach you with any questions
NOTE: As with any dental plan, the plan reimbursement may not cover the entire treatment cost.
To visit the Delta Dental website, go to www.deltadentalins.com.