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2013 Benefits Information

 

Delta Dental Insurance 

There are three dental plan options through Delta Dental Insurance. When it comes to dental plans, you want to select a plan with benefits that fit the needs of you and your family. Delta Dental's PPO and HMO plans offer comprehensive dental coverage while retaining quality care and excellent customer service, each plan has its own advantages.

Delta Dental PPO is a Preferred Provider Organization plan that gives you the freedom to visit any licensed dentist, anywhere in the world. To provide the lowest out-of-pocket cost however, you are encouraged to seek care from a PPO network dentist. A second option PPO is Delta Dental PPO Buy Up which excludes diagnostic and preventative care from the yearly maximum, allowing a greater benefit level for other basic and major services.

DeltaCare USA (also referred to as PMI or DHMO) offers cost-effective, comprehensive benefits through an established HMO network. To provide the lowest out-of-pocket cost, the plan requires enrollees to select a participating dentist within in the DeltaCare USA network. There are no maximums on general services when you are covered by the DeltaCare USA plan.

The City's dental plans have been restructured to reflect three coverage tiers (Single, Two-Party, Family). Depending upon your bargaining groups MOU, you may be able to waive dental.


Features Delta Dental PPO DeltaCare USA (HMO)
Copayments Covered services paid at applicable percentage All covered procedures have predetermined copayments (this means out of pocket costs are predictable)

No copayments or minimal copayments for most diagnostic and preventive services

No or minimal copayments for many restorative services
Dentist network Freedom to choose any licensed dentist, anywhere in the world, each time treatment is required Must visit an assigned DeltaCare USA network dentist to receive benefits
Selecting a dentist No need to preregister with a dental office

Ability to change dentists anytime without contacting Delta Dental



Ability to change network dentist with a phone call to PMI Customer Service
Access More than 13,000 PPO dentist locations in California and 87,000 nationwide More than 2,500 dentist locations in California
Coverage Lower your out-of-pocket cost by selecting a PPO network dentist

Out-of-network safety net offers cost protection to enrollees who visit a Delta Dental Premiere dentist who is not a member of the PPO network (91% of dentist in California are Delta Dental Premier dentists). Delta Dental Premier dentists may not charge patients more than the allowed fees

No exclusions for pre-existing conditions of missing teeth
Covers nearly 300 procedures


Orthodontic takeover provision for enrollees who have started orthodontic treatment under another dental HMO or fee-for-service plan.





No exclusions for pre-existing conditions or missing teeth
Out-of-area coverage Can visit any licensed dentist Out-of-area (35 or more miles from assigned network dentist) emergency care allowance up to $100 per incident
Deductibles/maximums PPO plans often have deductibles and annual maximums No annual deductible and no annual dollar maximums on general services
Administration No claim forms No claim forms

 

Informational Flyers

Last updated: 9/5/2013 1:08:00 PM