Q. If employees have a dependent child who is eligible for benefits as a full-time student, what documentation does Delta Dental require?

A. Please use our Student Documentation Verification form found in the Forms section of our Web site. This form is required to be filled out at the beginning of every fall school term.

Q. How did Delta Dental calculate the billing credit for the overage dependent child?

A. We reviewed our records back to January 1, 2007. If a dependent child was on our system but had not submitted full-time student documentation or he/she exceeded the age limit allowed under your contract, we terminated that coverage effective as of the point between January 1, 2007 and January 31, 2008 where the non-documented student status or the overage period started. If the termination resulted in a change to the coverage for which billing occurred, a credit was issued.

Q. Retroactive terminations are on the bill but no credits. Can you explain?

A. There are circumstances where terminations occur but no credits are due. For example, an employee changes from family coverage to employee/spouse coverage and the group has the same premium amount for each rate code. On your bill they will appear as an adjustment with the same dollar amount in the credit and debit column resulting in a zero dollar adjustment.

If you are a self-insured client, you are billed on a per subscriber per month basis. Changes in the number of dependents will not impact the rates charged to you by Delta Dental.

Q. Did Delta Dental pay claims for overage dependents?

A. Delta Dental verifies full-time student status for all clients for which we are contracted to do so. If the required student documentation was not submitted to us, we did not pay claims for that child.

For terminations that Delta Dental received retroactively from a client, if a claim had been already paid, Delta Dental’s normal billing practice is to issue a credit starting with the month after the claim was paid.

Q. How did Delta Dental verify full-time student documentation prior to the new 90/60/30 day letter process?

A. On an annual basis in August/September, Delta Dental would do a mailing to all members who had dependent children that were either full-time students or were approaching the minimum contract age where full-time student status was required. When documentation was received, that dependent child’s claims would be paid for the full school year. For dependents where the documentation was not received, claims were not automatically paid; rather, we initially denied such claims and retroactively processed them for persons who subsequently provided the required documentation of full-time student status. 

This new 90/60/30 day letter process will provide several reminders to subscribers of the need for documentation.

Q. What should I do if our group already provides Delta Dental enrollment for only those overage dependents that should be eligible?

A. Please write to Delta Dental’s Enrollment Department that you prefer we not verify full-time student status. Delta Dental will code our system to not include your employees/subscribers in the 90/60/30 day letter process.

The address is Delta Dental of New Jersey, Enrollment Department, 1639 Rt. 10, Parsippany, NJ 07054

Q. We verify full-time student status for our employees. Will letters be sent to subscribers?

A. Please write to Delta Dental’s Enrollment Department that you prefer we not verify full-time student status. Delta Dental will code our system to not include your employees/subscribers in the 90/60/30 day letter process.

The address is Delta Dental of New Jersey, Enrollment Department, 1639 Rt. 10, Parsippany, NJ 07054

Q. How do we correct an incorrect termination?

A. For questions about eligibility, reinstatement, or student documentation, please contact our Enrollment Department at (800) 452-9310. Full-time student documentation can be also be faxed to Delta Dental at (973) 285-4141.

Q. Does my group have the option not to terminate a child?

A. For those overage dependents retroactively terminated by Delta Dental in January 2008, if you prefer to retain coverage for these children, please contact our Enrollment Department at (800) 452-9310. Delta Dental will reinstate them through December 31, 2007 and debit your account accordingly.