Frequently Asked Questions

Delta Dental operates a toll-free customer service line. It is open 24 hours, and either you or a dentist can speak to a representative between the hours of 8:00 a.m. - 6:30 p.m. EST Monday through Thursday (Friday until 5:00 p.m.). Most questions can be answered by simply following the prompts using the automated voice response system. 

The phone number is: 1-800-543-0584 

Yes, a member may go to any dentist. Delta Dental has two dental networks available under this plan - Delta Dental Premier^® & Delta Dental PPO^™. Out-of-pocket expenses will be lowest with participating dentists, especially with a Delta Dental PPO dentist.

A participating Delta Dental provider, whether participating in the PPO or the Premier network, cannot charge you more than the Delta Dental maximum allowable charges for a given procedure within that network. Participating providers are contracted with Delta Dental to give you discounted services for covered benefits. A provider that participates in the PPO network will give you the deepest discounts.

Participating dentists have Delta Dental of New Jersey claim forms and will submit claims on your behalf. If the dentist does not participate, you may either bring a claim form to the dentist or Delta Dental will accept any ADA approved claim form the dentist’s office presently uses. Non-itemized bills, however, are not acceptable.

If your plan has an orthodontic benefit, Delta Dental recommends that the dentist submit a new claim for this treatment. The starting date of treatment and expected number of months of treatment should be included along with the charges. Delta Dental will coordinate coverage with the prior plan up to the lifetime maximum.

Your treatment will continue under your new Delta Dental plan but remember to tell your orthodontist that your carrier has changed. The amount paid by your prior insurance carrier will be applied to your Delta Dental plan. Have your Orthodontist submit a claim to Delta Dental of New Jersey. Delta Dental will work with your Orthodontist to obtain additional information about your treatment plan. Once Delta Dental receives the requested information, your claim will be processed and paid at the same quarterly payment schedule as under your previous carrier.

If you did not have prior dental insurance coverage but will be enrolling in Delta Dental’s new plan, you will be eligible for a pro-rated amount of the orthodontic benefits based on the number of months left in your treatment plan. Your orthodontist should submit a claim to Delta Dental of New Jersey. Have your Orthodontist submit a claim to Delta Dental of New Jersey. Delta Dental will work with your Orthodontist to obtain additional information about your treatment plan. Once Delta Dental receives the requested information, your claim will be processed.

Example of prorated claim:

Treatment plan: 24 months/12 months remaining
Orthodontic maximum benefit: $2,000
Number of months remaining in treatment: 12 (equal to 4 quarters)
Amount due for remaining 12 months of treatment: $1000 (divided by 4 = $250)
Total Amount Delta Dental will pay: $1000 (to be paid quarterly)

No. Your Orthodontia and TMJ history will transfer to Delta Dental. It is important to note that your plan will remain the same, only the carrier is changing. All Lifetime history accumulators will move over to Delta Dental. 

If you did not have prior dental coverage or had dental coverage from another carrier (not the Novartis Dental plan) but will be enrolling in the Novartis plan with Delta Dental, you will be eligible for a pro-rated amount of the orthodontic benefits based on the number of months left in your treatment plan. Your orthodontist should submit a claim to Delta Dental of New Jersey. Delta Dental will work with your Orthodontist to obtain additional information about your treatment plan. Once Delta Dental receives the requested information, your claim will be processed. 

Example of prorated claim: 

Treatment plan: 24 months/12 months remaining
Orthodontic maximum benefit: $2,000 
Number of months remaining in treatment: 12 (equal to 4 quarters)
Amount paid by MetLife:  $1,000 (divided by 4 = $250)
Delta Dental to Pay: $1,000 (to be paid quarterly)

Your treatment will continue under your new Delta Dental plan but remember to tell your orthodontist that your carrier has changed. The amount paid by MetLife will be transferred to Delta Dental to include in the calculation of your remaining orthodontic benefits. Have your Orthodontist submit a claim to Delta Dental of New Jersey. Delta Dental will work with your Orthodontist to obtain additional information about your treatment plan. Once Delta Dental receives the requested information, your claim will be processed and paid at the same quarterly payment schedule as under MetLife.  

Example 1: 

Treatment plan: 24 months with initial banding date of 3/1/24
Orthodontic maximum benefit: $2,000 
Number of months remaining in treatment: 15 (equal to 5 quarters)
Amount paid by MetLife:  $1,085 
Delta Dental to Pay: $915 ($183 to be paid in 5 quarterly installments) 

Example 2:

New treatment plan (no previous ortho history): 24 months with banding date of 1/15/25
Submitted total orthodontic fee:  $6,000 
Delta Dental Orthodontic Coverage:  50% with a $2,000 lifetime maximum
Orthodontic maximum benefit: $2,000 
Number of months in treatment: 24 (equals to 8 quarters)
Payment Schedule:  20% initial payment (quarter 1) and then remaining payments issued per quarter for duration of treatment plan (to be divided between 7 quarters)
First payment:  $400 (20% of $2,000)
Remaining Quarter Payments:  $229 to be paid during the remaining 7 quarters of your treatment plan 
Total Delta Dental Payment:  $2,000

Example 3:

New treatment plan (previous ortho history): 24 months with banding date of 1/15/25
Amount paid by MetLife for previous treatment (such as a palate expander): $500 (sometimes referred as Phase 1 treatment) 
Submitted total orthodontic fee:  $6,000 
Delta Dental Orthodontic Coverage:  50% with a $2,000 lifetime maximum 
Orthodontic maximum benefit: $1,500 (since MetLife previously paid $500) 
Number of months in treatment: 24 (equals to 8 quarters)
Payment Schedule:  20% initial payment (quarter 1) and then remaining payments issued per quarter for duration of treatment plan (to be divided between 7 quarters)
First payment:  $300 (20% of $1,500)
Remaining Quarter Payments:  $171 to be paid during the remaining 7 quarters of your treatment plan 
Total Delta Dental Payment:  $1,500

Easy! View and download your Member ID card by simply entering your member information without signing into your MySmile® account. 

Yes! Through our member portal, MySmiles. The website is www.deltadentalnj.com/novartis. Click on “Member” to access our member portal. Registration is required.

Delta Dental will allow benefits for the remaining amounts due once a claim is submitted. You should have your dentist submit the claim for service performed on the
date actual service(s) is/are completed. This amount is still subject to plan deductibles and maximums and/or any plan limitations or exclusions that exist.

Example: you started work for an implant and crown in 2024 with the crown to be completed in January 2025. The implant claim was processed and paid under MetLife, but the remaining crown procedure will be processed under Delta Dental. Have your provider submit the crown claim to Delta Dental and the crown will be processed by Delta Dental (subject to plan deductibles and maximums).

All services completed while covered under the Novartis plan (such as crowns, bridgework, dentures, root canals, TMJ treatment*, etc.) will be paid according to your plan deductibles/maximums even if the work was initiated under MetLife and completed under Delta Dental.

*TMJ (Temporomandibular Joint) is subject to a separate lifetime maximum of $1,500. Your TMJ history with MetLife will move to Delta Dental. For example, if you previously used $500 for TMJ services then you will have $1,000 remaining in your lifetime maximum.

You should have your dentist submit the prior approval along with a claim for the date(s) the service(s) were performed, and Delta Dental will honor MetLife’s approval determination (subject to Delta Dental allowed/approved charges).

Example: If you were issued a MetLife pre-treatment estimate for a crown in late 2024, Delta Dental will honor the approval to receive treatment. The cost of the estimated treatment may be different than MetLife’s approved amount. Have your provider submit the MetLife pre-treatment estimate along with your crown claim for processing. The claim will be processed according to Delta Dental’s allowed/approved charges.

By visiting a participating dentist, you will maximize your benefit and may have lower out-of-pocket costs. However, if you see an out-of-network dentist, Delta Dental will process the claim and pay in accordance with the maximum allowable charges for each procedure. You may be required to file a claim on your own and be responsible for paying the dentist directly. Delta Dental may then reimburse you for services up to the allowed amount. Since Delta Dental cannot control the fees of non-participating dentists, balance billing for charges greater than the allowed amount is possible.

This benefit is for any member that may have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management. It allows you to receive up to four total dental cleanings in a benefit year, additional exams, and treatment delivery modifications including anesthesia. Talk with your provider about this benefit enhancement and that your dental plan includes these additional benefits. For more detailed information and a flyer please visit our website.

If you reside in New Jersey please visit the New Jersey Dental Association website to search for a Delta Dental dentist near you.  This site is limited to New Jersey dentists only.  To find a provider in your state you may need to contact your current provider for recommendations.  

The Integrated Care benefit allows you to receive up to 2 additional cleanings and/or periodontal maintenance procedures per calendar year if you have been diagnosed by your physician as having either diabetes, heart disease, or pregnancy.   Ask your physician to complete and sign our Integrated Oral Health Qualification form, which can be found by clicking the link or by going to the Download Forms section of our website.

Members with certain medical conditions, such as diabetes or heart disease will only need to complete the form once. Members who are pregnant will be eligible for this benefit during the duration of their pregnancy.  

The Oral Health Enhancement benefit allows you to receive up to 2 additional cleanings and/or periodontal maintenance procedures per calendar year if you have a history of periodontal disease.  In order to receive this benefit please either send a copy of your explanation of benefits from a prior carrier that shows you have had periodontal surgery or scaling and root planing; or have your dentist complete the Oral Health Enhancement Qualification form, which can be found by clicking the link or by going to the Download Forms section of our website.  

If you have noticed changes in your hearing, Delta Dental has teamed up with Amplifon to offer you savings on hearing aids.  For additional information on this savings program please visit our website.  Our goal in addition to oral health and wellness is to help you restore the precious sounds of your life!