Delta Dental of California
Customer Service Number 1 888 335-8227
www.deltadentalca.com
Plan Choices
| Plan | Cost |
|---|---|
| Service Plan A ($1,000 annual maximum) | $80.00/ mo |
| Service Plan B ($1,500 annual maximum) | $95.00/ mo |
| Service Plan C ($2,000 annual maximum) | $125.00/ mo |
Your dental program covers several categories of benefits, when the services are provided by a licensed dentist, and when they are necessary and customary under the generally accepted standards of dental practice. Delta will pay 70% of the covered fees for the covered preventive, basic, and crown and cast benefits during the first calendar year of eligibility. This percentage will increase 10% each year for each enrollee, provided that person has visited the dentist during that year, to a maximum of 100%. If you do not use the program in a calendar year, the percentage remains at the level you reached the previous year. The percentage will drop back to 70% if you lose eligibility and then become eligible again.
Delta will pay 50% of covered fees for covered prosthodontics benefits (replacement of missing teeth). 100% of dental accident benefits, and 50% of orthodontic benefits for dependents. (Percentages for these services do not increase as they do for preventive, basic, etc.) Payments for orthodontic benefits are limited to a lifetime maximum of $1,000 for dependent children no matter which level of plan is chosen.
Limitations
- An oral exam is a benefit only if the dentist has an accepted fee on file with Delta.
- Oral examinations are benefits only twice in a 12-month period.
- Prophylaxes (cleaning), fluoride treatments or procedures that include cleanings, are benefits only twice in a 12-month period.
- Unless special need is shown, full mount x-rays are benefits only once in a three-year period.
- Supplementary bitewing x-rays are benefits only once in a six month period.
- Periodontal procedures that include cleanings are subject to the same limitations as other cleanings; (i.e. cleanings of any kind are benefits no more than twice in any 12 month period.
- Pit and fissure sealants are limited to eligible dependent children under age 14. Sealant benefits include the applicant of sealants only to permanent posterior molars with no caries (decay), with no restorations and with the occlusal surface intact. Sealant benefits do not include the repair or replacement of a sealant on any tooth within three (3) years of its application.
- Crowns, jackets and cast restoration are benefits on the same tooth only once every five years.
- Prosthodontics appliances are a benefit only once every five years, unless Delta determines that there has been such an extensive loss of remaining teeth, or a change in supporting tissues, that the existing applicant cannot be made satisfactory.
- Delta will pay the above percentage of the dentist's fee for a standard partial or complete denture up to a maximum fee allowance.
- Implants (appliances inserted into bone or soft tissue in the jaw, usually to anchor a denture) are not covered.
- X-rays and extractions that might be necessary for orthodontic treatment are not covered by orthodontic benefits, but may be covered under diagnostic and preventive or basic benefits.
Information accurate for calendar year 2006