Program Overview

• DeltaCare: A Managed Dental Care program

  The DeltaCare managed dental care program is administered by Flagship Dental Plans, a wholly owned subsidiary of Delta Dental of New Jersey, Inc. DeltaCare is a comprehensive managed care dental HMO-type program. Patients select a primary care dentist who provides necessary dental care and coordinates referrals for specialty care. Primary care (general) dentists receive a monthly capitation payment for members who select their office. This amount is supplemented with patient copayments for certain services, depending on the plan selected by the member's employer. Specialty services performed by the general dentist are reimbursed on a schedule of maximum allowable charges.

  DeltaCare offers members a choice of primary care in private practice locations, all of whom meet facility standards established by Flagship Dental Plans, based on accepted standards of dental care.

• Capitation Payments

  Flagship will pay the plan primary care dentist a monthly capitation fee. This fee will be considered payment for all dental services provided to covered members unless the service is either not covered by the plan, or requires the member to pay a copayment directly to the primary care dentist.

  The monthly capitation fee will vary among group policy holders depending on the plan each employee chooses. Plans with lower monthly capitation fees will have higher relative patient copayments, and plans with higher monthly capitation fees will have lower relative payment copayments. More detailed information concerning capitation fees is included in our information kit.

• Non-Covered Services

  For non-covered services, the dentist may charge his or her usual fee and look directly to the member for payment. In such cases, the plan primary care dentist agrees to a) advise the member of services professionally recommended but excluded from coverage; b) give the member the option to proceed with such services at the member's expense; and c) explain that the member will be responsible for the total fees for these excluded procedures.

• Specialty Care Services

  The plan primary care dentist may agree to provide some specialty care dental services that he or she is qualified to perform and which has been approved for referral by Flagship. For these services, the dentist agrees to accept the schedule of maximum allowable charges for specialty services as payment in full. Flagship will issue a claim payment for covered specialty services, less any required patient copayment.

• Specialty Care Referrals

  Specialists available to DeltaCare participants include oral surgeons, endodontists, periodontists, and orthodontists. DeltaCare has recently modified the specialty referral process in an effort to simplify the administration of the DeltaCare program. For most endodontic and oral surgery services, eligible DeltaCare enrollees can be referred directly from the primary care dental office to participating DeltaCare specialists. Orthodontic referrals require just a phone call to confirm orthodontic coverage prior to referral. More extensive treatments will still require preauthorization. This process is explained in detail in the Specialist section.

• Member Communications

  Managed dental care programs can represent a significant change for employees. The success of the transition depends upon understanding how to use the managed care network and what benefits are available, as well as the plan exclusions and limitations.

Flagship provides information to members in a "question and answer" format to assist in communicating the plan benefits to employees. Flagship also provides a benefit booklet that details all of the plan benefits, as well as the scheduled copayment amounts for covered benefits so that employees can make a well-informed decision and understand any financial obligation they may have for certain services.

Click here to contact our Network Coordinator via e-mail

Or notify Flagship in writing or via fax/e-mail of the change.

DeltaCare/Flagship Dental Plans
1639 Route 10
P.O. Box 369
Parsippany, New Jersey 07054
Attention: Network Coordinator

Phone: 1-800-722-3524 x4048
Fax: 973-285-4162

DeltaCare is underwritten and administered by Flagship Dental Plans, a wholly-owned subsidiary of Delta Dental of New Jersey, Inc.