Who are my contacts for getting a proposal and getting appointed?

Getting a proposal is fast and easy. To get started, just contact us or complete the online RFP request! For brokers who are not yet appointed, we routinely assist with client presentations. In the meantime, we invite you to visit our Product Information section for more information.

New case approval requires that we have that a signed Agent Agreement along with a copy of your current insurance license. Delta Dental of New Mexico pays the appointment fee for every broker with an active Delta Dental account.

We look forward to working with you and answering any questions you might have about our products.

Does Delta Dental provide proposals to more than one broker for the same group?

Yes. In multiple quote situations, both brokers are notified that another broker has requested a proposal. Each quote is based on the information provided by the broker making the request, so plan designs, etc. may not be identical.

What is required for a broker of record change?

Any change in the insurance broker who is currently servicing a group must be requested by an authorized employer representative and approved by Delta Dental. Broker of record letters need to include a specific effective date the change is requested and a statement indicating an understanding that commissions, if any, will no longer be paid to the prior broker. No retroactive changes can be accepted and any requests must be in writing on the employer’s letterhead. Delta Dental will provide a courtesy notice to the prior broker.

Please contact us if you have any questions or if you would like to receive a copy of our Agent Agreement or sample broker of record letter wording.

Will Delta Dental of New Mexico assist with enrollment meetings?

Yes! Delta Dental of New Mexico assigns an Account Executive to every large account (over 50 enrolled subscribers). Our Account Executives work with plan administrators and brokers to complement and support the claims and administrative services being provided to the employer. In addition to providing quality service to the group, we are committed to providing brokers with prompt responses and expert assistance.

Who handles service after a group is effective?

Delta Dental Account Executives work with plan administrators and brokers on all groups with over 50 enrolled subscribers to provide personal, and frequently on-site, services to the group. Our experienced Account Executives are responsible for contract revisions, assistance with enrollment meetings, production of reports – anything the broker or the group might need to get the most value from their dental benefits program. Delta Dental Account Executives are knowledgeable service professionals, averaging over 15 years experience in our industry.

Employers with fewer than 50 enrolled employees are serviced through our Group Service Center. A Delta Dental of New Mexico innovation, the Group Service Center enables smaller employers to have a single point of contact for any help they need with billing, enrollment or the renewal process. Each GSC representative handles a block of business, assigned by group number. Like our Account Executives, they are committed to providing plan administrators and brokers with exceptional service and support.

Why should employers consider Delta Dental for their employees?

Established in 1954, Delta Dental is the country’s largest and oldest dental insurance company, covering over 45 million people nationally. The New Mexico affiliate, Delta Dental of New Mexico, has been providing quality dental plans and administration since 1973. Enrolled employees and their dependents – over 200,000 New Mexicans – are serviced from Albuquerque where all claims processing, customer service, and provider relations are managed by experienced administrators and governed by a board of directors comprised of New Mexico residents.

Delta Dental of New Mexico is especially proud of the customer service and claims turnaround statistics that reflect our commitment to excellence. Click on our Report Card to view them now.

As a non-profit dental benefits organization, Delta Dental believes in contributing to our New Mexico community. As part of our mission to improve the oral health of the members we serve, we strive to continually find ways to provide the most cost-effective dental plans with an emphasis on preventive care. Our “give back” philosophy is the foundation of the business decisions we make and the contributions of time and financial support we give to organizations that improve the quality of life in our state.

What plans does Delta Dental of New Mexico have available to large employer groups?

Most employer groups enrolling from 3-100 eligible employees are enrolled in the Delta Dental of New Mexico Small Group Pool.

Large employers may select from one of several standard plan designs or create a custom plan design that incorporates non-standard features.

Delta Dental of New Mexico offers large employers fully insured plans, voluntary group products and Administrative Only Services for self-funded benefit plans.

For more detailed information on standard plan designs click on Product Information or contact us for personalized assistance.

What plans does Delta Dental of New Mexico have available to small employer groups?

Depending on the number of eligible employees, Delta Dental has up to five different plan designs for employers who wish to contribute to the premium cost for their employees. Within each basic plan design there are also coverage options, such as different deductible amounts or plan maximums, which give employers many ways to meet their individual coverage and budget goals.

For more information, please click on our Product Information section or contact us. We look forward to the opportunity to answer your questions.

What is the minimum size group Delta Dental of New Mexico will enroll?

To be eligible for coverage, the employer group must enroll a minimum of three eligible employees. In addition, Delta Dental’s participation and other underwriting requirements must be met.

The plans available to each employer depend on the number of eligible employees enrolling.

For more information on the minimum group size required for each plan, please click on our Product Information section or contact us.

Do employers need to have an insurance agent or may they contact Delta Dental directly?

There is no requirement for an employer to be represented by an insurance agent or broker. Most employers, however, appreciate the help an insurance professional can provide. In addition to guiding employers through plan selection decisions, most insurance brokers assist in the enrollment process and provide after-the-sale service to their clients.

While Delta Dental provides the same quality service to an employer group with our without a broker, most Delta Dental of New Mexico business is written through insurance brokers. The broker is selected by the employer and then appointed by Delta Dental of New Mexico.

How are insurance brokers or consultants with Delta Dental business compensated?

In most cases, Delta Dental pays brokers a commission based on the group size or a predetermined percentage of premium. Having a broker does not, however, increase the employer’s premium cost for any of the plans designed for employers with fewer than 100 employees enrolled (Delta Dental of New Mexico’s Small Group Pool).

Some large employers elect to pay their brokers directly through consulting fees, which are not included in the dental insurance premiums.

When do new employees become eligible for their dental plan?

To be eligible, an employee must meet the full time and other eligibility definitions established by the employer and approved by Delta Dental. Eligible employees are covered following an eligibility waiting period.

As an example, in Delta Dental’s Small Group Pool (plans specially designed for employers enrolling fewer than 100 employees) the waiting period for new employees is 90 days. An employee must work full time for 90 days before becoming eligible to enroll. Coverage then becomes effective the first of the following month.

Different waiting periods are available, subject to underwriting approval, to larger employers or employers with an approved business need requiring different eligibility rules.

How many providers participate with Delta Dental?

Delta Dental of New Mexico has multiple plans, featuring different networks. Every Delta Dental dentist participates in Delta Dental Premier, which offers the broadest selection of dentists and over 700 points of access in New Mexico – over 90% of the dentists in our state! Delta Dental Premier is also one of the nation’s largest networks, with participating dentists in every state.

Many Delta Dental Premier dentists also participate in Advantage Plan, a PPO exclusive to New Mexico which provides cost savings and a comprehensive provider network with over 450 points of access around the state.

Delta Dental PPO is Delta Dental’s second national network. Offering the most affordable premiums and greatest savings, it is a somewhat smaller network with over 315 points of access in New Mexico and participating dentists in every state.

Delta Dental participating dentists are key to the unique cost management system called The Delta Dental Difference^SM. They agree to charge our patients only the fees approved by Delta Dental for covered services. Additionally, our cost management system incorporates coordination of benefits, utilization reviews, in-office fee audits and peer review, saving our purchasing groups millions of dollars annually.

Learn more about The Delta Dental Difference^SM advantages here, or let us know if you have any questions about our unique network choices. Our most up-to-date network directories are available by clicking Dentist Search.

What is “The Delta Dental Difference_SM”?

Three out of four dentists in the United States are Delta Dental Dentists, the largest network in the industry.

With all Delta Dental plans, full benefits apply when the network selected by the group is used. Patients who use non-network dentists may have additional out-of-pocket costs (depending on what the individual dentist charges) but there is never a requirement to use only network dentists. Delta Dental subscribers have benefits for covered services with any dentist, anywhere.

If a non-network dentist is used by a patient enrolled in Advantage Plan or Delta Dental PPO, the amount of any additional non-network cost can be capped by making sure a Delta Dental Premier dentist is selected. Delta Dental Premier dentists will not balance-bill patients for any amount over and above Delta Dental Premier approved fee maximums, regardless of the plan selected by the employer. In addition, dentists in every Delta Dental network will submit a claim on behalf of the patient, eliminating the requirement of many non-network offices for the patient to pay first and wait for reimbursement.

Please let us know if we can tell you more about our unique network choices or more fully explain The Delta Dental Difference^SM;. Our most up-to-date network directories are available by clicking Dentist Search.

How do I get a benefits and price proposal?

You may request a proposal from Delta Dental of New Mexico by completing our online RFP form or through any of the phone numbers listed in our contact us section

For employers who will be enrolling fewer than 100 employees, Delta Dental of New Mexico has standard plan designs and rates that apply to all new groups (our Small Group Pool products). Most insurance brokers have current plan and rate information on hand, so employers may request a proposal from the broker with whom they are already working. If a broker is not familiar with Delta Dental of New Mexico products, we promptly respond to requests for proposals and can begin the process of getting a broker appointed to represent our products.

The request for proposal (RFP) should include:

1. Company name, address and telephone/fax numbers.
2. A description of the type of business, and a contact name at the company.
3. The broker name and contact numbers, if applicable.
4. Information on the total number of eligible employees and the employees in other categories: part time, seasonal, ineligible for benefits (due to length of employment or other eligibility criteria) and those already covered by other group dental insurance.
5. A list of employees desiring coverage, indicating which employees need dependent coverage.
6. An indication of which, if any, employees are located in a different city.
7. The percentage of premium (employee and dependent) that will be contributed by the employer.

For smaller employer groups, specific plan design requests are not required -- our proposals include benefit and pricing options for every plan available!

Larger employers should submit the same information listed above along with any additional information that may apply, such as:

1. The desired coverage effective date.
2. Claims experience from the in-force dental insurance plan (12 months past claims and enrollment information).
3. A copy of the group’s current benefits as well as any coverage changes requested.
4. A copy of the group’s current rates and the renewal rates from the in-force carrier, which help determine the rate structure most appropriate (two-tier, three-tier or four-tier).
5. Dependent enrollment information that matches the rate structure desired.

For a fast response to your proposal request,complete our online RFP form or contact us by phone today!

What are Delta Dental of New Mexico's participation requirements?

Delta Dental's underwriting requirement is that 75% of all eligible employees enroll. Employees with other group dental insurance do not have to be included in the number eligible, meaning 75% of employees not covered elsewhere need to enroll in the Delta Dental plan.

Sometimes a higher percentage of enrollment is required. As an example, since the minimum group size is five, a group with only five eligible employees requires 100% enrollment.

Please contact us for more information about eligibility or participating requirements.

Is the employer required to contribute toward the premium?

Generally, yes. Delta Dental of New Mexico requires the employer to contribute a minimum of 50% of the employee premium. Delta Dental does not require the employer to contribute toward the dependent premiums. Large employers may be eligible for Voluntary benefit plan designs, which do not require an employer contribution.

In addition to the plans designed for employers who are providing dental insurance as an employee benefit, in mid-2005 Delta Dental will introduce new Voluntary plans for smaller employers. These plans, which don’t require an employer contribution to the premium, enable employers to assist employees in obtaining valuable dental insurance by payroll deducting their individual premiums.

For more information, please contact us. We look forward to the opportunity to answer your questions.

What is required to get a new group approved?

To be approved by the first of a calendar month, the enrollment requirements listed below should be received by Delta Dental on the 20th of the prior month so benefit and enrollment information can be entered by the effective date.*

 1. A group application completed by the employer. The application required will vary depending on the size of the employer group and the plan requested:

Small Group Pool Application (Used for all plans when coverage is being written in Delta Dental of New Mexico’s Small Group Pool).


Delta Dental Premier application (Large employer groups selecting standard or custom designed Delta Dental Premier plans).

Advantage Plan application (Large employer groups selecting a standard or custom designed Advantage Plan).

Advantage Plan POS application (Large employer groups selecting a standard or custom designed Advantage Plan POS).

Delta Dental PPO application (Large employer groups selecting a standard or custom designed Delta Dental PPO).

Delta Dental PPO POS application (Large employer groups selecting a standard or custom designed Delta Dental PPO POS).

 2. A completed enrollment form for every employee. Those electing coverage should indicate the coverage requested (employee or employee and dependent). Those declining coverage should sign the Waiver of Coverage section.

 3. A check made payable to Delta Dental of New Mexico for the estimated first month’s premium.

 4. A copy of the last billing (immediately prior to the requested effective date) from the prior dental insurance carrier, if applicable.

 5. When applicable, a copy of the most recent SUTA form.

What is a SUTA form?

"SUTA" refers to the State Unemployment Tax Wage and Contribution Report, also called a Schedule A. Each quarter, employers submit this form to the State of New Mexico. Delta Dental uses a copy of the form to verify the number of full time employees and confirm that enrollment participation requirements are being met. Depending on the size of the group, a copy of the most recent SUTA may be required with the group application and / or in conjunction with the group's renewal.

If a husband and wife both work for the same company, may they enroll separately?

Yes. Married employees who are both eligible for coverage may enroll separately or together, but not both. Children of married employees may only be enrolled under one parent.

What is a Missing Tooth Exclusion?

A Missing Tooth Exclusion means that the replacement of any tooth missing prior to an enrolled person’s effective date with Delta Dental is not covered for the duration of the contract.

This exclusion generally applies to initial and new enrollees in groups who did not have prior dental coverage, but individual subscribers should check benefits specific to their plan of benefits.

With Delta Dental, and all other dental insurance plans, there are standard exclusions and / or limitations. It is important to understand both what is covered and what is not. Delta Dental Benefit Service Representatives are available to answer benefit questions by phone. In addition, Delta Dental will work with a dentist to provide a Predetermination. A Predetermination allows the patient and the dentist to know what will be covered before any major services are provided.

Whom do I call at Delta Dental when I have billing or enrollment questions?

Delta Dental of New Mexico structured their Group Service Center with you in mind! Staffed by a team of courteous, well-trained representatives, this unit was designed to give employers and brokers a single point of access for their most common questions. Billing, eligibility and enrollment services are all handled by an account specialist assigned to the group. Simply identify the employer’s name or group number when you call, and you will be connected to your service representative.

To talk with the Group Service Center call (505) 883-4777 or (800) 999-0963 Monday-Friday 8:00 AM to 4:30 PM Mountain Time.

Whom do I call at Delta Dental when I have a claims or benefits question?

Delta Dental of New Mexico has a team of benefit experts who are able to quickly and accurately provide plan or member-specific answers.

Our specially designated Benefit Services phone lines are never answered by a computer! Highly trained and efficient Benefit Service Representatives answer their own calls and have one of the industry’s best response time records. Click here to view our most recent Report Card.

Please note: Delta Dental of New Mexico is 100% committed to protecting every individual’s privacy rights. Some kinds of claims questions can’t be answered for a broker or an employer if they involve claim history on an employee or employee family member.

Benefit Services: (505) 855-7111 or (877) 395-9420 Monday-Friday 8:00 AM to 4:30 PM Mountain Time.

Subscribers may also use Delta Dental of New Mexico’s Subscriber/Consumer Toolkit for fast, easy to use and secure access to information about their benefits!

Is there a way for employees to get information about their benefits online?

Yes. Delta Dental’s online Consumer Toolkit is fast, free, easy to use and available 24/7!

Covered subscribers and their spouses can print their own subscriber ID (Reference Card) and have secure access to information about their benefits, including:

1. Levels of coverage specific to their benefit plan and type of service.
2. Up-to-date individualized information on deductibles met and remaining plan maximums.
3. Details on specific claims – when and how paid.
4. Oral Health information and our privacy protection policies.

Subscribers: You may access Delta Dental of New Mexico’s Subscriber/Consumer Toolkit now!

How does a current subscriber change the way he/she is enrolled?

To request changes to the way a subscriber is enrolled, an employee should first contact the employer’s Plan Administrator or Human Resources Department. Depending on the employer’s plan requirements, some changes may only be made during an Open Enrollment period. Some changes, called Qualifying Events, enable an employee to make changes prior to Open Enrollment if the change is requested within 31 days of the event. The birth of a child and the marriage or divorce of an enrolled subscriber are examples of a Qualifying Event. The Plan Administrator can also advise the employee of changes, if any, to the premium contribution required.

Some changes, such as becoming ineligible for coverage because of a divorce, may trigger eligibility for COBRA continuation if the employees works for an employer subject to COBRA.

Employees should check with their Human Resources department or Plan Administrator for enrollment requirements specific to their plan.

How do I add a new or newly eligible employee?

Once eligibility is confirmed by the employer, new employees should complete a Delta Dental enrollment form, indicating single or dependent coverage. In order to expedite approval, please make sure all the requested information, such as social security number, date of hire, and dependent names, if applicable, have been accurately provided. Sometimes employee handwriting and signatures are hard to read! Your help in making sure names and addresses are legible will also help make sure claims are processed accurately.

Please contact us if you have any questions about the eligibility requirements or eligibility waiting periods that were established for your plan.

Questions? To talk with the Group Service Center call (505) 883-4777 or (800) 999-0963 Monday-Friday 8:00 AM to 4:30 PM Mountain Time.

How do I delete an employee who has terminated employment?

The same enrollment form used for adding new employees is used to notify Delta Dental that a subscriber is no longer eligible. Simply complete the areas of the card applicable to termination of coverage, including the employee’s name, social security number and the date of employment termination. Then just sign the form and send the original to Delta Dental.

Employer’s subject to COBRA will also, of course, be responsible for the COBRA-required notifications to employees or dependents who are losing group plan eligibility.

Questions? To talk with the Group Service Center call (505) 883-4777 or (800) 999-0963 Monday-Friday 8:00 AM to 4:30 PM Mountain Time.

Do I pay as billed, or adjust my premium statement for changes that have occurred?

Delta Dental will approve and make applicable premium adjustments, credits or debits, so the employer should pay the premium statement as billed. Any debits or credits will be reflected in the following month.

To talk with the Group Service Center call (505) 883-4777 or (800) 999-0963 Monday-Friday 8:00 AM to 4:30 PM Mountain Time.

Does my group’s future participation affect future eligibility?

It could. If a group drops below the total number of enrolled employees required, the employer group will become ineligible for that plan. The employer will have the option of switching to a plan, if available, for smaller employers. Whenever possible, Delta Dental also allows time for the employer to meet the minimum enrollment required by adding a new employee.

If the percentage of eligible enrolled employees falls below the required level, the group’s eligibility can also be affected.

As a general rule, Delta Dental's participation requirement is that 75% of all eligible employees must enroll. Individuals with other group dental insurance count as having coverage, so the requirement refers to 75% of employees not covered elsewhere. Sometimes a higher percentage of enrollment is required. As an example, since the minimum group size is three, a group with only three eligible employees requires 100% enrollment.

Please contact us for more information about eligibility or participating requirements.

When is the premium due each month?

Delta Dental mails premium statements on or around the 25th of the month prior to month in which premiums are due. Premium payments are due upon receipt of the billing, on the first of each month. Timely payment of premiums is important to avoid problems that can otherwise arise when a dentist office calls to verify benefits. Premiums are considered past due as of the 10^th of the month for which coverage was billed.

How do we get a quote for a benefit change or a coverage enhancement?

On most plans, Delta Dental offers four annual plan maximums between $1,000 and $2,000. In addition, employers may elect the savings created by higher annual deductibles. Large employers have multiple custom plan design options. Just let your broker, Delta Dental Account Executive or Group Service Representative know what changes you’d like to consider. We’re happy to provide information on pricing or coverage differences – whatever you’ll need to evaluate your options. Plan changes need to be authorized by the employer or Plan Administrator and are generally approved effective with a group’s coverage anniversary date.

contact us if we can help!

May I change insurance brokers?

Delta Dental of New Mexico works closely with insurance brokers and, together, we strive to provide you with unparalled service. Please don’t hesitate to call on us anytime you need help or information and you cannot reach your broker.

Any change to the insurance broker who is currently servicing your group must be requested by an authorized employer representative and approved by Delta Dental. No retroactive changes can be accepted and any requests must be in writing on the employer’s letterhead. Delta Dental will work with the new broker to expedite any paperwork which might be required and will also provide a courtesy notice to the prior broker.

May subscribers choose any of the dentists in their plan’s Delta Dental network?

Yes! Patients may change dentists as often as they like without notifying Delta Dental and each member of the family may select a different dentist.

What are the advantages of seeing a participating dentist?

Enrollees have many reasons, including the highest level of benefits, to select a Delta Dental participating dentist but have the freedom to choose any dentist, anywhere. In addition:

1. Delta Dental guarantees that when patients receive covered dental services from a dentist in their plan’s network, out-of-pocket costs will be limited to deductibles and copayments (subject to plan maximums).
2. Any Delta Dental participating dentist – anywhere – will file a claim on behalf of the patient, eliminating the need to pay first and wait for reimbursement. There is no paperwork for patients to file!
3. To help keep benefits affordable and control patient out-of-pocket costs, all Delta Dental participating dentists agree to fees within Delta Dental Maximum Approved Amounts.
4. Delta Dental participating dentists agree on credentialing, quality assurance and claims processing policies, important protections for enrollees.

Our most up-to-date network directories are available anytime by clicking Dentist Search.

Do I have coverage if I see a non-network dentist?

Yes! Although the full level of benefit applies only when the Delta Dental network applicable to your plan is used, Delta Dental subscribers have benefits for covered services with any dentist, anywhere.

Patients who use non-network dentists may have additional out-of-pocket costs (depending on what the individual dentist charges). If you are enrolled in a Delta Dental network other than Delta Dental Premier, however, the amount of any additional non-network cost can be capped by making sure a Delta Dental Premier dentist is selected. Delta Dental Premier dentists have agreed to maximum fees, which can reduce the additional cost you might otherwise have at a non-network dentist. In addition, Delta Dental Premier dentists anywhere will submit a claim on behalf of the patient, eliminating the requirement of many non-network offices for the patient to pay first and wait for reimbursement.

Our most up-to-date network directories are available anytime by clicking Dentist Search.

Do I have coverage in another state?

Yes! Although the full level of benefit applies only when the Delta Dental network applicable to your plan is used, Delta Dental subscribers have benefits for covered services with any dentist, anywhere.

Patients who use non-network dentists may have additional out-of-pocket costs (depending on what the individual dentist charges). If you are enrolled in a Delta Dental network other than Delta Dental Premier, however, the amount of any additional non-network cost can be capped by making sure a Delta Dental Premier dentist is selected. Delta Dental Premier dentists have agreed to maximum fees, which can reduce the additional cost you might otherwise have at a non-network dentist. In addition, Delta Dental Premier dentists anywhere will submit a claim on behalf of the patient, eliminating the requirement of many non-network offices for the patient to pay first and wait for reimbursement.

Our most up-to-date network directories are available anytime by clicking Dentist Search.

Do Delta Dental patients need a coverage ID card at the dentist office?

There is no requirement to carry an ID card! Delta Dental benefits are easy to use. Subscribers just need to say they are on a Delta Dental plan and provide the dentist’s office with a social security number.

As a courtesy to subscribers, a Delta Dental Reference Card is provided to every subscriber so patients have easy access to our address and phone numbers.

Is a claim form required?

Any Delta Dental participating dentist – anywhere – will file a claim on behalf of the patient, eliminating the need to pay first and wait for reimbursement. When care is received from a Delta Dental dentist, there is no paperwork for patients to file!

How can I find out what my share of the cost will be for treatment I’m considering?

Delta Dental of New Mexico has a team of benefit experts who are able to quickly and accurately tell you plan or member-specific benefits. For major services, asking for a Predetermination of Benefits is the best way to know exactly what out-of-pocket costs to anticipate.

To talk to a Benefit Services representative, call (505) 855-7111 or (877) 395-9420 Monday-Friday 8:00 AM to 4:30 PM Mountain Time. To request Predetermination of Benefits, just ask your Delta Dental dentist.

Subscribers may also use Delta Dental of New Mexico’s Subscriber/Consumer Toolkit for fast, easy to use and secure access to information about their benefits!

What is a "Predetermination of Benefits"?

When a dentist recommends major services, we strongly encourage the dentist to submit a treatment plan to Delta Dental for a Predetermination of Benefits. We promptly notify both the patient and your dentist if the recommended treatment is a covered benefit, how much Delta Dental will pay, and what the patient’s financial obligation will be.

Predetermination is never required but the service is provided, free of charge, to Delta Dental patients. Ask your dentist about Predetermination anytime you have questions about your share of the cost of major services.

Does Delta Dental offer individual dental insurance plans?

Not at this time. Currently, Delta Dental of New Mexico offers a dental discount program known as Delta Dental Patient Direct.