Retiree dental

Your share of the cost of services depends on whether you use a dentist in Delta Dental’s PPO network or an out-of-network dentist. Delta Dental has more than 17,500 PPO dentists in California and 114,800 nationwide. To see a list of Delta Dental PPO dentists, visit the Delta Dental website.

Your total annual benefit per person (including preventive, basic, major and prosthetic dental services) is $1,700 if you see a Delta Dental PPO dentist and $1,500 if you see a Premier or out-of-network dentist. A $50 deductible applies for some services.

Dentists in Delta Dental’s PPO network agree to accept a reduced fee for services and will complete and submit all claim forms for you at no charge.

• Preventive services (exams and cleanings) are free of charge, with no deductible.
• Basic dental services, such as fillings and extractions, are covered at 80% after you meet the deductible.
• Most other dental care is covered at 50% after you meet the deductible.

Delta Dental’s Premier dentists are not in the PPO network but have agreed to accept a reduced fee for services and also will complete and submit claim forms for you. Delta Dental covers 80% of basic dentistry costs after the annual deductible if you use a Premier dentist, up to $1,500 per year.

If you go to a dentist not affiliated with Delta Dental, you may have to pay the dentist’s total fee and then submit your claim form to Delta Dental for reimbursement. Delta Dental cannot assure you what percentage of the charged fees may be covered.

When you enroll, you select a network dentist to provide all your basic dental services and to refer you to specialists when necessary. The DeltaCare® USA network consists of private practice dental facilities that have been screened by Delta Dental for quality.

There are no deductibles or maximum benefit amounts for DeltaCare HMO. You pay only your copayment (if any) for covered services at the time of treatment. See the DeltaCare Plan Summary for details on covered services and copayments.

You may change your dentist at any time by calling the Delta Care Customer Service number to request the change. Visit the Delta Dental website for a list of participating dentists.