Handbook

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Table of Contents

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Section 1

1.0- Welcome To Delta Dental of Arkansas :01
1.1- Eligibility 1:04
1.2- If you need us 1:16
1.3- Using this handbook 1:28
1.4- When there are changes 3:05

Section 2

2.0- Dental Care 3:15
2.1- When should your child see a dentist 3:17
2.2- What to expect at the dentist for children 3:54
2.3- Taking care of teeth at home 5:14
2.4- Babies and toddlers 6:14
2.5- Children age 3 and over 7:35

Section 3

3.0- Primary Care Dentist 8:31
3.1- What is a primary care dentist 8:36
3.2- Choosing a PCD 9:02
3.3- Using a dentist who is not your child’s PCD 9:41
3.4- Changing your PCD 10:00
3.5- Choosing a dentist not in the network 10:16
3.6- What if my PCD leaves the network 10:40
3.7- Scheduling an appointment 10:53
3.8- What if I need to cancel my dental visit 11:13
3.9- What if I miss an appointment 11:34

Section 4

4.0- ID Cards 12:00
4.1- How to replace a lost ID card 13:28

Section 5

5.0- Non-Emergency Transportation 13:52

Section 6

6.0- Billing Information 16:29
6.1- How much do I pay when my child sees a dentist 16:31
6.2- How to file a claim 17:36
6.3- What if I get a bill 17:55
6.4- Is there a maximum amount Delta Dental will pay each year 18:15
6.5- If you have other dental insurance 18:25
6.6- Other times we may not pay for services 18:47

Section 7

7.0- Dental Emergency 19:16
7.1- What is an emergency dental condition 19:19
7.2- What to do in a dental emergency 19:34
7.3- What if I’m out of Arkansas and have a dental emergency 20:23

Section 8

8.0-Covered Services 21:10
8.1- Covered early periodic Screening Diagnosis and treatment (EPSDT) 21:45
8.2- Covered services for children 22:41
8.3- Covered dental services 23:00
8.4- Lifetime benefits 25:52
8.5- Prior authorizations (approval) 26:11

Section 9

9.0- Services Not Covered 26:43
9.1- Services that are not covered 27:14

Section 10

10.0- Member Rights and Responsibilities 27:28
10.1- Member Rights 27:43
10.2- Member Responsibilities 32:28
10.3- Use your benefits wisely 34:01

Section 11

11.0- Grievance and Appeal 34:23
11.1- How to file a grievance or ask for an appeal 34:27
11.2- What is a grievance 34:45
11.3- How do I file a grievance 34:59
11.4- Processes and timeframes 35:39
11.5- What is an appeal 36:52
11.6- How do I file an appeal 37:20
11.7- Processes and timeframes 38:36
11.8- State Fair Hearing 42:06
11.9- Continuing your child’s benefits 43:36

Section 12

12.0- Fraud, Waste, Abuse and Overpayments 45:20
12.1- Fraud, waste, abuse and overpayments 45:25
12.2- Definitions 45:59
12.3- Examples of fraud, waste, abuse and overpayments 46:34
12.4- Report of fraud, waste, abuse and overpayments 47:29

Section 13

13.0- Your Child’s Privacy 48:53
13.1- Your child’s protected health information 49:12

Appendix 
A-Helpful Information 52:01
B-Taglines and Non-Discrimination Disclosure 53:28