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Additional Coverage Details
Coverage begins following premium payment. Your coverage will take effect on the first day of the month following the date we receive your application and initial premium. The initial coverage period is for 12 months, regardless of the terms, conditions and coverage period of your medical plan. Delta Dental guarantees not to change your premiums during those 12 months, and you agree to pay premiums on time for those 12 months. Your effective dental coverage date may or may not coincide with your medical coverage date. Only dental treatments begun and completed while coverage is in force are eligible for benefits. Cancellation. You may only purchase the dental plan within 60 days of purchasing the Simply Blue medical plan. You may cancel the Delta Dental plan at its renewal date without cancelling the medical plan; however, once dental coverage is cancelled, you cannot re-enroll for two years. You’ll find complete details in the Delta Dental Benefit Plan Summary. This brochure is intended to provide a convenient overview of coverage and is not intended to be a complete description. Only those services and supplies specifically listed in the Delta Dental Benefit Plan Summary are covered under the plan, regardless of dental necessity. Please note that treatment for a missing tooth is not immediately covered under this plan. The Delta Dental Benefit Plan Summary is your source for complete information, including the specific dental treatments that are covered, the frequency with which those treatments are covered, benefit amounts, limitations, exclusions and conditions under which coverage may remain in force. Exclusions and limitations are also available at www.deltadentalmn.org. You will receive the Delta Dental Benefit Plan Summary with your welcome package. If you decide this coverage is not for you, simply let us know in writing within 10 days of receiving the Summary. We will then promptly refund your paid premium, minus any paid claims. You will not be eligible to re-enroll for two years. |
A dental plan for your way of life You’re on your own. You’re in charge. And getting health care coverage to protect you was priority one. That’s why you chose Simply Blue. Now, you can take charge of your oral health by purchasing a dental plan designed to complement your Simply Blue plan. It’s a smart move, especially as a growing body of evidence links oral health to overall health. Plus, you have a choice of coverage options and prices to fit your needs and budget. These plans are available exclusively for Simply Blue members through a special arrangement with Delta Dental of Minnesota — the state’s largest dental benefits administrator. Get coverage you can count on When you choose this dental plan, you can be sure that you’ll get the kind of coverage you expect, including:
Enrolling in this dental plan is fast and simple. Your application form is included on the application page. Just fill it out. Then print the completed application, and drop it in the mail to: Individual Dental Delta Dental of Minnesota Attn.: Enrollment Department P.O. Box 330 Minneapolis, MN 55440-0330 If you have questions or need help completing the application, call customer service at (651) 406-5995 or toll free at 1-888-223-2954 |
