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Health Fund

Filing A Claim

One of the advantages of using a Delta Dental dentistA doctor of dentistry who is licensed to practice dentistry at the time and place involved where the particular dental procedure was rendered. is that you do not have to file a claim form. These dentists will take care of all claims paperwork for you. However, when you use a dentist who is not part of Delta Dental's network, you may have to file a claim form on your own. Claims for dental care from a non-network provider should be submitted to Delta Dental within 90 days of your visit, and no later than two years after the expense was incurred.

When you need to file a claim form, here's what to do:

  • Contact the Administrative Office or log on to Delta Dental's website at to download a Delta claim form online.
  • Complete sections 1 through 15 of the claim form.
  • Attach a copy of the dentist's Statement of Treatment, including the dentist's name and phone number.
  • Once the form is completed, make a copy for your records and mail the original to:

    Delta Dental Plan of California
    P.O. Box 997330
    Sacramento, CA 95899-7330

Claims are usually processed by Delta Dental within two weeks of receipt, unless additional information is required from you or your dentist. (For more information about filing claims, see "Claims and Appeals Rules".)