Delta Dental Patient Direct® Program offered by Delta Dental of Illinois Member Terms and Conditions.
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On behalf of myself and my dependents (if applicable) (collectively referred to as "Members"), I agree to the following terms and conditions for membership in the Delta Dental Patient Direct Program through Delta Dental of Illinois (referred to as “Delta Dental”).
1. The Delta Dental Patient Direct Program (“Program”) offers access to a network of dentists who have agreed to provide discounts for dental services pursuant to the Delta Dental Patient Direct Fee Schedule. A current copy of the Delta Dental Patient Direct Fee Schedule may be viewed and printed from the Program’s website at http://patientdirect.deltadentalil.com. Members may also contact Delta Dental of Illinois Customer Service between 8:30 a.m. and 5:00 p.m. at 800-323-1743. The range of discounts will vary depending on the dental service received. This Program is not an insurance plan. Delta Dental is not an insurer, guarantor or underwriter of any services provided under the Program. Delta Dental shall in no event be liable for any payment to a dentist accessed under the Program. This Program is limited to dental services rendered in the State of Illinois and Members must reside in the State of Illinois.
2. The dentists who participate in the Delta Dental Patient Direct Network are independent contractors in private practice and are neither employees nor agents of Delta Dental and/or its subsidiaries or affiliates. The availability of any particular Delta Dental Patient Direct Network Dentist cannot be guaranteed, and the inclusion of any particular dentist in the Delta Dental Patient Direct Network is subject to change without notice.
3. Delta Dental does not provide dental treatment and is not responsible for outcomes. All dental care is the responsibility of the treating dentist in consultation with the Member. Selection of the Delta Dental Patient Direct network dentist is also the responsibility of the Member.
4. Dentists in the Delta Dental Patient Direct Network have agreed to make certain services available to Members at the fee level set forth in the Delta Dental Patient Direct Fee Schedule. Members arrange for dental care and for payment directly with the participating dentist in the Delta Dental Patient Direct Network. Members are obligated to pay for all discounted services. Delta Dental neither makes benefit payments to Members nor compensates dentists for services they provide to Members. All payments for dental services rendered are due and payable at the time of service, unless another payment arrangement is mutually agreed upon between the Member and the treating dentist. Members shall be responsible for the treating dentist's office policies, such as payment for missed appointments or late payments.
5. In order to receive services at the level set forth in the Delta Dental Patient Direct Fee Schedule, a Member must present his/her program ID card to the dentist's office at the time of his/her appointment.
6. Delta Dental reserves the right to terminate a Member's participation in the program with 30 days notice, for any reason.
7. Members have the right to cancel membership in the Program within the first 30 days or at the end of the 12-month membership period. If, for any reason, a Member elects to cancel his/her membership within 30 days after receiving an ID card and other membership materials and so notifies Delta Dental in writing, the annual membership fee will be refunded in full.
8. A Delta Dental Patient Direct Network general dentist may bill Members at or below the discounted fee indicated on the Delta Dental Patient Direct Fee Schedule. For those services with a percentage discount, a Delta Dental Patient Direct network general dentist may bill Member his/her usual fee, discounted at 20%. Delta Dental Patient Direct specialty dentists and orthodontists may bill Members for his/her usual fee, discounted 20%, for all procedures he/she performs. The usual fee is the fee most often charged and collected by the treating dentist participating in the Delta Dental Patient Direct Network from patients without insurance. The recommended treatment may require the dentist to perform more than one procedure, and as such the dentist may bill you for more than one fee for a given course of treatment.
9. No person, other than the Member and his/her eligible dependents, if applicable, are entitled to any rights under the Delta Dental Patient Direct Program. Membership is not transferable, and membership in the Program may be terminated immediately in the event that Members or his/her dependents, if applicable, provide any ineligible individual access to the Member’s ID card (or otherwise provide unauthorized access to the Program).
10. Eligible dependents under a family program include a spouse/domestic partner and/or one or more eligible child dependents. Eligible child dependents include the Member’s and Member’s spouse’s, if applicable, natural born children or stepchildren, legally adopted children, children whom the Member and Member’s spouse have legal guardianship and who are wholly dependent upon the Member and Member’s spouse for most of his/her support and maintenance, and foster children. Proof of support or adoption and all other matters pertaining to eligibility as a dependent must be submitted to Delta Dental when requested.
11. Eligible dependent children are included under the Member’s family membership (if selected by Members) until the end of the calendar year in which they attain the age of 26.
12. A child otherwise defined above but who has obtained age 26 and who Delta Dental determines is incapable of self-sustaining employment by reason of mental or physical handicap or developmental disability shall be considered a child under this program if he/she depends on the Member or the Member’s spouse for support and maintenance and had the condition before attaining age 26. Proof of disability must be submitted to Delta Dental of Illinois when requested.
13. The Delta Dental Patient Direct Program does not apply to any dental treatment the Member elected and received or began prior to the date the Member notified the Delta Dental Patient Direct Network Dentist (by presenting his/her membership ID card) of his/her membership in the Program. Any procedures performed by a dentist who does not participate in the Delta Dental Patient Direct Network are not included in the Program. Any Member accepted for orthodontic treatment must remain a Member of the Delta Dental Patient Direct Program for the full duration of his/her treatment or risk additional charges from his/her network orthodontist.
14. Members who have dental insurance are not eligible for the Delta Dental Patient Direct Program. The Delta Dental Patient Direct Program cannot be used in connection with any dental insurance or benefit coverage, including Delta Dental, and cannot be used in connection with any other type of insurance, including but not limited to medical and accidental injury insurance. The Delta Dental Patient Direct Program does not coordinate benefits with any insurance or benefit programs. Delta Dental has the right to confirm Members are not currently enrolled in any other Delta Dental program.
15. Delta Dental has no liability for providing and does not guarantee dental services, and is not liable for the quality of any dental services rendered.
16. This Delta Dental Patient Direct Program is only available if included services are performed by a participating dentist in the Delta Dental Patient Direct Network. It is the Member’s responsibility to ensure the dentist is participating in the Delta Dental Patient Direct Network even when referred by a network dentist to a specialist or to another dentist. A listing of current network dentists, including network participating specialists may be found at http://patientdirect.deltadentalil.com. Please note that dental offices participate in various Delta Dental programs. If a Member calls an office that he/she believes is participating in the Delta Dental Patient Direct Network (always use the specific term “Delta Dental Patient Direct” not the general term “Delta Dental’) and that office indicates it does not participate in the network, immediately call Delta Dental Patient Direct customer service at 800-323-1743. (Please be aware of the fact that not all of the dentists in a dental practice may participate in the Delta Dental Patient Direct Network; it is best to be specific when calling to ask about network participation.)
17. Applications, along with the applicable membership fee, must be received by the 20th of the month to be effective the 1st of the following month (i.e., applications submitted on February 19 will be effective March 1). Applications received after the 20th will be effective the first of the month after the next month (i.e., applications submitted on February 21 will be effective April 1). The annual membership fee can only be paid by credit card. Notification of the effective date will be emailed with a welcome packet and ID card(s).
18. The Delta Dental Patient Direct Fee Schedule is subject to change by Delta Dental. Changes shall not occur more than once per calendar year.
19. All applicants for membership must be 18 years or older. Parents can enroll a dependent child, but payment by credit card (the credit card holder) must be made by an individual 18 years or older.
20. By signing the attached application, the Member acknowledges that the Member has read and understands the above terms and conditions and agrees to abide by them.
21. Communications to Delta Dental of Illinois with respect to the Delta Dental Patient Direct Program shall be sent via email to: firstname.lastname@example.org, or to the following mailing address:
Delta Dental of Illinois
Attn: Patient Direct
111 Shuman Blvd.
Naperville, IL 60563
22. Communications to Delta Dental regarding complaints with respect to the Delta Dental Patient Direct Program shall be sent via email to: email@example.com, or to the following mailing address:.
Delta Dental of Illinois
Attn: Patient Direct
111 Shuman Blvd.
Naperville, IL 60563
Illinois Department of Insurance
320 W. Washington Street
Springfield, IL 62767-0001
Telephone (217) 782-4515