OCA Dental Benefits

Delta Dental of Ohio

We are pleased to announce our partnership with Delta Dental of Ohio, who will be administering your dental benefits. Delta Dental of Ohio provides you and your family with more access to in-network dentists than ever before, which means you will pay less out of pocket for covered dental services.
Charges for services and supplies are covered by the plan under the following four categories of dental treatment:
Benefits will be paid for necessary dental services or supplies furnished or prescribed by a dentist and for prophylaxis provided by a hygienist up to the annual maximum benefit of $1,000 per person. This maximum benefit does not include orthodontia, which is tracked separately and described below.

1. Preventive Dentistry
, covered at 100% of the Delta Dental fee schedule, includes examinations (diagnosis and x-ray), prophylaxis (cleaning of teeth), and x-rays. Such services are covered one time every six months. Panoramic or Full Mouth x-rays are limited to one every 24 months.

2. Basic Dental Services
, covered at 80% of the Delta Dental fee schedule, include:

  • Extraction of teeth;
  • Fillings;
  • Palliative service (to relieve pain); and
  • Root canal treatment.

3. Major Dental Services
, covered at 50% of the Delta Dental fee schedule, include:

  • Prosthetic appliances (dentures, partial dentures, bridgework and crowns);
  • Repair of prosthetic appliances;
  • Periodontic treatment procedures; and
  • Treatment of temporomandibular joint disorders.

4. Orthodontics
, covered at 50% of the Delta Dental fee schedule, includes the orthodontic treatment procedure, diagnosis, evaluation and pre-care. Orthodontic benefits have a lifetime benefit of $1,000 per person, in addition to the annual maximum set forth above.

Save Money on Dental Services

Delta Dental has two levels of in-network dentists, Delta Dental PPO and Delta Dental Premier. With the Delta Dental PPO, you may save more money and receive higher levels of coverage because Delta Dental PPO dentists have agreed to accept lower fees as full payment for covered services. However, if you go to a dentist who doesn’t participate in Delta Dental PPO, you can still save money if your dentist participates in Delta Dental Premier. Like the PPO dentists, Delta Dental Premier dentists agree to accept Delta Dental’s fee determination as full payment for covered services.

Delta Dental Networks
Delta Dental PPO
  • No balance billing on covered services
  • Most significant network discounts with more than 381,800 office locations nationwide
  • Dentists file claims for member
Delta Dental Premier
  • No balance billing on covered services
  • Significant network discounts with the most office locations nationwide - more than 448,400
  • Dentists file claims for member
Out of Network
Out-of-network Dentist
  • May be balance billed
  • No discounts
  • May need to file own claims
Finding an In-Network Dentist

Visit www.deltadentaloh.com/findadentist to find an in-network dentist near you. Remember that using a PPO dentist will save you the most money. When you call to make an appointment with the dentist you choose, simply tell the dental office you have benefits through Delta Dental of Ohio.

Contacting Delta Dental

If you have questions about your benefits, claims, ID cards or network dentists, you can contact Delta Dental’s customer service team at 1-800-524-0149 Monday to Friday 8:30 am to 8 pm EST. Their automated inquiry system is available 24/7 and can answer many of your questions.

Download the Mobile App

By downloading the Delta Dental Mobile App, you can search for dentists without logging in, or enter your username and password and securely access your personal benefit information or estimate your dental care costs. You can also pull up your ID card right on the app and show it to your dentist right on your mobile device, or easily save it to your device and quickly access it using Apple Wallet or Google Pay.

To download the app on any device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental.

Submitting a Claim for Reimbursement

Delta Dental PPO and Delta Dental Premier dentists submit claims for you. If you visit an out-of-network dentist, you may need to file your own claim. Printable claim forms are available to download within the Member Portal at www.memberportal.com or from the Delta Dental of Ohio website, www.deltadentaloh.com. Either you or provider can complete the form and attach a copy of your bill. The completed reimbursement forms should be mailed to:

Delta Dental
PO Box 9085
Farmington Hills, MI 48333-9085

Benefit Exclusions and Limitations

No dental benefits are available for any of the following:

  • Treatment in connection with full dentures, partial dentures, or bridgework, under the following circumstances:
    • If the work in making the full or partial dentures or bridge began prior to the effective date of the eligible person's coverage;
    • If the full denture, partial denture, or bridgework is a duplicate replacing the same teeth as the existing appliance, except when in attending dentist's opinion the appliance is damaged beyond repair, in which case payment is limited to once every three years; or
    • If lost or stolen dentures are replaced more often than once every five years.
  • Any amount payable under the medical benefits provision of the Plan for surgical procedures which are also covered under dental benefits; amounts received as medical benefits shall be deducted from the amount of dental benefits payable.
  • Treatment incurred and supplies received or ordered prior to the date of eligibility.