Please click the link below to access your member specific benefits through Benefits Express
Making healthy simpler
Your member website
Connect with Delta Dental of New Jersey in just a few clicks!
To provide some guidance on “who to contact” or “how to resolve” member claim issues or general claim questions, we’ve put together the below quick reference guide as well as frequently asked questions which we hope will help you navigate the health care system for your employee health benefits program(s).
Guidelines for Claim Questions / Issues
New Employees -Eligible to enroll after eligibility period.
Existing Employees- you can only add dependents during open enrollment in the fall of each calendar year to be effective for January 1st of the following calendar year unless you are adding a new spouse or newborn child to your plan. (see FAQ#10 for newborns)
Please see your groups benefits coordinator for an enrollment / change form. You MUST complete an enrollment form for dependents to be covered, including a newborn child regardless of already having family coverage.
(Please note – you may remove dependents at any time).
Medical (Aetna) or Delta Dental (Dental) Coverage
If you are having a claim issue: i.e; balance due bill, denial of a claim / services, verify eligibility of services, etc.,
- First step- call the member services phone number on the back of your member ID card to discuss / review with an Aetna or Delta Dental Customer Service Representative.
- Second step- If you do not resolve or reach a satisfactory solution contact your benefits coordinator for assistance. They will gather the information regarding your issue(s) and forward to our office, the Office of the Program Manager for assistance or to your broker, who will coordinate the review and resolution of the issue with our office.
Prescription Coverage (Express – Scripts)
- If you are having an issue with a prescription being denied or want to check on coverage of a certain medication, please contact the member services phone number on the back of your member ID card to discuss issues or questions with an Express – Scripts Customer Service Representative. As with your medical and / or Dental coverage, if you need additional assistance in the resolution of your prescription / medication issues, please see your benefit coordinator for who will contact our office or the brokers office for assistance.
If you feel more comfortable contacting our office directly (or your brokers office directly) to discuss your claim issue(s), you may do so. Please contact your benefit coordinator for the appropriate contact information.
You may also find it helpful to register on the carrier’s websites to review your claim information, obtain information on discounts available, print member ID cards and more.