Using Your Benefits
Welcome to Delta Dental of Iowa and the Dental Wellness Plan!
The Dental Wellness Plan (DWP) gives you comprehensive benefits with a focus on preventive services. Taking care of your teeth is good for your health. Delta Dental’s goal is to give you access to quality dental care with DWP benefits to help you keep your teeth healthy.
Covered Dental Benefits
The DWP is for adults enrolled in the Medicaid program. DWP allows members to access dental services when you see a DWP Delta Dental dentist.
Download the summary of covered benefits
Annual Benefit Maximum
DWP, like many other dental plans, has an Annual Benefit Maximum (ABM) of $1,000. This is the maximum dollar amount the DWP will pay toward the cost of dental care during a benefit year (example: July 1 – June 30).
Services That Do Not Apply
The following services do not apply to the Annual Benefit Maximum:
- Exams, x-rays, cleanings, sedation related to oral surgery, dentures and services that are needed for emergent situations
- DWP members that are 19 and 20 years old do not have an Annual Benefit Maximum
Delta Dental pays your dentist for covered services, up to your $1,000 Annual Benefit Maximum. You will not have to pay for covered dental services if you see a dentist or clinic that is part of the DWP Delta Dental network if you stay within your Annual Benefit Maximum.
What happens if I reach my $1,000 annual benefit maximum?
If you have reached your $1,000 Annual Benefit Maximum and the service(s) you receive are not on the excluded list of services, you need to pay for these services even if they are covered under your plan.
Find a Dentist
You must go to a DWP Delta Dental dentist to use your DWP benefits. You can find a network dentist online here or call us at 1-888-472-2793.
View Your Benefits
You can view the dental services you have and have used. You will need to register to view this section of the website.
Fraud, Waste, and Abuse
- Fraud - A false or wrong action used to get something of value.
- Waste - The misuse of services.
- Abuse - Refers to getting services that are used too much or are not needed at all.
To learn more about how these can affect your Dental Wellness Plan benefits, or how to report these actions, watch the video below.
DWP Member Handbook
The DWP member handbook gives you information on your benefit plan and rights as a DWP member. If you would like a hard copy mailed or emailed to you please call 888-472-2793 or email [email protected].
DWP Member Rights and Responsibilities
Getting dental health services is a private matter. We respect your right to privacy. You have the rights and duties listed below:
You have rights if you get services through the Dental Wellness Plan. These rights are listed below. You have the right to:
- Be treated with respect, dignity, and privacy.
- Receive care no matter your race, color, nationality, disability, sex, religion or age.
- Get correct, easy to understand information.
- File a grievance (complaint) about us, a dentist or the care you receive.
- File an appeal about an action or decision we made. You can ask for a state fair hearing if you are not happy with the results of the appeal.
- You have a right to know:
a. How Delta Dental decides whether a service is covered and/or dentally necessary.
b. Who in Delta Dental’s office decides those things.
- The names of the dentists in the Dental Wellness Plan Network.
- Pick from a list of dentists that is large enough that you can get the right kind of care when you need it.
- Take part in all the choices about your dental care and receive information to make these choices.
- Speak for yourself in all treatment choices including the right to refuse treatment.
- Get a second opinion from another dentist about what kind of treatment you need at no cost to you.
- Be treated fairly by Dental Wellness Plan Network dentists and other dentists.
- You have the right to:
• Talk to your dentist in private
• Have your dental records kept private
• Request a copy of your dental records
• Ask for our changes to those records
- Know that dentist who care for you can advise you about:
• Health status
• Dental care
- Know that you are not responsible for paying for covered services. Dental Wellness Plan Network Dentists cannot require you to pay any other amount for covered services. See “When Do I Pay for Services” on Page 17 of the member handbook.
- Receive information in other forms such as Spanish, larger font, Braille, etc. Please contact us toll-free at 1-888-472-2793. You can receive this information and get a spoken translation in most languages at no cost.
- To get care coordination from Delta Dental. We can help you find a dentist or specialist, make an appointment, and find resources to make sure you can get to your appointment. If you need help with any of these things, please call us at 1-888-472-2793.
- Recommend changes in policies and services under the Dental Wellness Plan. You can write us or call toll-free 1-888-472-2793.
- Receive services free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- Exercise any of these rights without negative consequences from your provider(s) or Delta Dental.
There are things you need to do as a Dental Wellness Plan member. Agreeing to them helps you get the most out of your dental services. It also helps us work with you better.
- You must present your Delta Dental of Iowa issued Dental Wellness Plan member ID card at every dentist appointment.
- Keep your contact information (address and phone number) up to date. You can update your address with Delta Dental Member Services or Iowa Medicaid Member Services.
- You should try to follow healthy habits, such as exercising, staying away from tobacco, and eating a healthy diet.
- You should work together with your dentist to pick a treatment that you have agreed upon. You should get information from your dentist to make informed choices about your treatment.
- If you have a disagreement with Delta Dental, you should try first to resolve it using Delta Dental’s Grievance Process beginning on Page 21 of this handbook.
- You should learn about what the Dental Wellness Plan does and does not cover.
- You should read your Member Handbook to understand how the rules work.
- If you make an appointment, you should try to get to the dentist’s office on time. If you cannot keep the appointment, be sure to call and cancel it.
- You should report waste, abuse and fraud immediately. This may be about Delta Dental, or other dental or medical plans. See Page 27 of the member handbook on how to report waste, abuse or fraud.