Additional Information

If you are planning an extended out-of-country stay and you require major services, we strongly urge you to request a predetermination. We will process the predetermination and notify you if the recommended treatment is a covered benefit, how much Delta Dental will pay, and what your financial obligation will be.

Below is a list of procedure information that is required to process your claim. Please request this vital information from your dentist prior to treatment or before completion of your treatment:

• If the claim is for a crown, bridge, or partial, your dentist needs to indicate if this is initial placement.
• If it is not initial placement, your dentist needs to provide the initial placement date and the reason for the replacement. Please submit this information with your claim form.