Dental Coverage Changes for 2019 - Updated

Effective January 1, 2019, Delta Dental of Virginia will no longer administer the Pediatric Oral benefit for our Individual & Family and Small Group Plans.

Optima Health will cover this service and all related pre-authorizations, claims, and appeals in 2019 for the remainder of the plan year for Small Groups until their 2019 renewal. For example, if a group has a November 1, 2018 effective date, Optima Health will cover pediatric dental claims until October 31, 2019. Members should seek necessary services from a licensed dental provider in the Commonwealth of Virginia. Providers will be instructed to send all claims to the following address:

ATTN: Claims Department
Optima Health
P.O. Box 66446
Virginia Beach, VA 23462

Optima Health will no longer cover pediatric oral services for new or renewing plans in 2019. Please advise your renewing groups to seek coverage under a standalone dental carrier.

Also effective January 1, 2019, Optima Health will no longer offer the Delta Dental Preferred/Bundled dental partnership. If you have any questions, please contact your Optima Health Sales team.

For your reference, this letter was sent to members of impacted groups.

Your Optima Health Team

Please note: Pediatric dental coverage is an essential health benefit under the Affordable Care Act (ACA); however, since carriers like Delta Dental offer stand-alone dental plans in our service area, 2019 Optima Health Small Group plans are ACA compliant without the benefit included.