Delta Dental Premier

Wesleyan University offers two dental plan options through Delta Dental of New Jersey. Although both plans allow you to choose any dental provider, when you use an in-network dentist, you will generally pay less for treatments because your share of the cost will be based on negotiated discount fees. With out-of-network dentists, the plan will pay the same percentage, but the reimbursement will be based on out-of-network rates. You may be billed for the difference.

Participating Providers

Delta Dental has more than 2,500 participating dental offices in Connecticut and more than 145,000 participating offices nationwide. You may use any fully licensed dentist under this plan. Participating dentists will be paid directly by Delta for covered services. Non-participating dentists will bill you directly, and Delta may make claim payments directly to you. You will maximize benefits and reduce paperwork by using a Delta-participating dentist.

To see a current provider directory, please visit deltadentalnj.com and chose the Delta Dental PPO Plus Premier plan, or you may obtain a current listing of participating dentists in any area by calling 1-800 DELTA OK (1-800-335-8265). Provide your zip code to the representative, and a directory for that area will be mailed to your home.

At the time of your first appointment, tell the dentist that you are covered under this program and provide your group number (6507) and Wesleyan ID number. Your dependents, if covered, should provide your Wesleyan ID number.

Coverage Details

This overview contains a general description of your dental care program for your use as a convenient reference:

Carryover Maximum Benefit

This benefit feature allows you to carry over a portion of your unused annual maximum in one year to increase benefits for the following year and beyond.

To qualify for carryover maximum benefits, you must meet the following criteria:

You must enroll on or before January 1st of the Carryover Maximum benefit year. Members enrolling after January 1st are not eligible to accrue carryover benefits until the start of the next plan year.
You cannot use more than 50% of the annual maximum during the plan year.
You must see a dentist during the plan year for an exam or cleaning and submit a claim for those services. If a claim for an exam or cleaning is not received, any accumulated Carryover Maximum benefit will be lost.

If you meet these criteria, you can accumulate 25% of the unused annual maximum. You can continue to accumulate benefits up to twice the annual plan maximum (annual benefits plus accumulated benefits), therefore the accumulated amount will never exceed the annual plan maximum amount. Claims will always use the plan’s annual maximum first. The accumulated benefit is applied when the standard annual maximum is exhausted.

Education and Support Resources

Questions

Claim questions and other information needs should be directed to Delta’s benefits services department at 1-800-452-9310. Wesleyan’s group number is 6507.

Benefit Disclaimer

Benefit summaries are provided for the convenience of Wesleyan employees. Employees are directed to read the relevant benefit plan documents. In the event of a conflict between the terms of any summary and the terms of actual plan documents, the terms of plan documents will control. Except where prohibited by collective bargaining or other agreement, Wesleyan reserves the right to alter, modify, or suspend any benefit at any time. While Wesleyan selects its benefit providers after thoughtful review, it disclaims responsibility for the ultimate performance of such providers.