Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Carryover Max℠
Carryover Max allows you to accumulate part of your unused benefit dollars from one year into future years. Carried-over benefit dollars increase your annual maximum and help pay for future covered services, such as bridges, crowns, and root canals.
It's easy to qualify.
Get your annual check-up.1 That’s it.
1. If you use less than half of your yearly benefit dollars, we’ll take the difference between your annual maximum and what you actually used and multiply that by 25%.2
2. We’ll add that amount to your next year’s annual maximum to use for planned or unplanned expenses.
3. Unused yearly carryover funds will accumulate (capped at your standard annual maximum amount), so you don't lose them.
4. You can accumulate multiple years’ carryovers (up to $500 per year), potentially doubling your benefit dollars.
You get more flexibility in planning and paying for your dental care, as well as the peace of mind knowing you have more benefits—if you need them, when you need them.
Still have questions about Carryover Max? Call us at 800-452-9310.
1 To qualify for Carryover Max, you must receive at least one cleaning or oral exam during each plan year. If you miss an annual cleaning or exam in a later year, any accumulated carryover will be lost.
2 You can roll up to $500 in unused dollars into the following year. Unused yearly carryovers can accumulate up to your standard annual maximum.
3 If you use less than one half of your standard annual maximum, then you are eligible for Carryover Max.
4 In Year 3, the $1,500 standard annual maximum was exceeded, but the member had enough Carryover Max dollars accumulated ($500) to cover the additional $100 cost.
5 In order to be eligible for the Carryover Max benefit, a covered person must have seen a dentist at least once during the benefit year for an Oral Evaluation (exam) or Prophylaxis (cleaning) and submitted a claim for these services to Delta Dental.
In Connecticut, Delta Dental Insurance Company writes dental coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs.
It's easy to qualify.
Get your annual check-up.1 That’s it.
How Carryover Max works:
1. If you use less than half of your yearly benefit dollars, we’ll take the difference between your annual maximum and what you actually used and multiply that by 25%.2
2. We’ll add that amount to your next year’s annual maximum to use for planned or unplanned expenses.
3. Unused yearly carryover funds will accumulate (capped at your standard annual maximum amount), so you don't lose them.
4. You can accumulate multiple years’ carryovers (up to $500 per year), potentially doubling your benefit dollars.
Here’s an example of how Carryover Max is applied year over year.
| Year 1 | Year 2 | Year 3 | Year 4 | |
|---|---|---|---|---|
Your standard annual maximum amount |
$1,500 | $1,500 | $1,500 | $1,500 |
| Carryover amount from previous year | N/A | $275 | $500 | $400 |
| Total benefit dollars available; | $1,500 | $1,775 | $2,000 | $1,900 |
| Your total claims paid3 | $400 | $600 | $1,6004 | $200 |
| Cleaning or oral exam during the prior year | Yes | Yes | Yes | Yes |
| Carryover amount earned | $275 | $225 | $0 | $325 |
| Accumulated Carryover Max total available | $275 | $500 | $400 | $725 |
Carryover Max increases your dental benefit value
You get more flexibility in planning and paying for your dental care, as well as the peace of mind knowing you have more benefits—if you need them, when you need them.
Carryover Max qualifications and rules
- If you disenroll from your plan (for example, if you marry and enroll under your spouse’s plan), you will lose your accumulated carryover amount.
- If you do not receive a routine cleaning or exam during the benefit period, your accrual will be lost.
- If you receive a routine cleaning but used more than half of your annual plan maximum, you will retain any accruals; however, you will not accrue additional carryover dollars this benefit period.
- Carryover Max does not apply to lifetime maximums that may exist, such as orthodontics.
- Eligibility for Carryover Max is based on your benefit year.5
- If you enroll after the effective date of the benefit period, you will not be eligible to begin carryover accrual until the beginning of your group’s next benefit period.
- Claims not received by the last day of the benefit year may affect any Carryover Max dollars credited the following benefit year. If claims for services covered in the prior benefit year are received after the date the maximum is calculated, the calculation will be adjusted accordingly, and you may be required to pay back Delta Dental the excess benefit you received.
- Out-of-pocket expenses will be based on the coinsurance amount for the services received, generally 20% to 50%.
Still have questions about Carryover Max? Call us at 800-452-9310.
1 To qualify for Carryover Max, you must receive at least one cleaning or oral exam during each plan year. If you miss an annual cleaning or exam in a later year, any accumulated carryover will be lost.
2 You can roll up to $500 in unused dollars into the following year. Unused yearly carryovers can accumulate up to your standard annual maximum.
3 If you use less than one half of your standard annual maximum, then you are eligible for Carryover Max.
4 In Year 3, the $1,500 standard annual maximum was exceeded, but the member had enough Carryover Max dollars accumulated ($500) to cover the additional $100 cost.
5 In order to be eligible for the Carryover Max benefit, a covered person must have seen a dentist at least once during the benefit year for an Oral Evaluation (exam) or Prophylaxis (cleaning) and submitted a claim for these services to Delta Dental.
In Connecticut, Delta Dental Insurance Company writes dental coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs.
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
