Dental Benefits
Delta Dental
Delta Premier |
Under the Delta Premier program, you may visit any licensed dentist you wish. However, you receive the maximum benefits available under the program when you choose one of the more than 17,000 in-network dental offices throughout California.
More than 17,000 dentists in California are Delta Dentists, including Delta Premier dentists. Delta dentists agree to abide by Delta's fee and quality guidelines. |
Delta Premier Dentist |
Non-Delta Dentist |
Your out-of-pocket expense will probably be less because Delta Premier dentists have agreed to charge Delta Premier patients reduced fees.
You may be charged only the patient share at the time of treatment, not Delta's portion |
You will be responsible for the dentist's fees, which may be higher than those approved by Delta
You may have to pay the entire amount in advance and wait for reimbursement. |
Principal Benefits and Covered Services |
When treatment is provided by... |
An In-Network Dentist |
Who's covered |
Primary enrollee, Spouse, Eligible Dependent children to age 24* |
Deductibles and Benefits Maximum |
$25 per person, $75 per family per calendar year. (No deductible applies if a DPO dentist is used)
The maximum benefit paid per calendar year is $1,500 per person |
Diagnostic and Preventive Benefits* |
70 - 100% of Delta Premier approved
(no deductible applies for these services) |
Basic Benefits* |
70 - 100% of Delta Premier approved fee |
Crowns, Jackets and Cast Restorations |
70 - 100% of Delta Premier approved fee |
Prosthodontic Benefits* |
50% of Delta Premier approved fee |
Accident Benefits |
70 - 100% of Delta Premier approved fee |
Delta Preferred Option |
Under the Delta Preferred Option program, you may visit any licensed dentist you wish. However, you receive the maximum benefits available under the program when you choose one of the more than 8,600 in-network dental offices throughout California.
More than 17,000 dentists in California are Delta Dentists, including Delta Preferred Option dentists. Delta dentists agree to abide by Delta's fee and quality guidelines. |
In-Network DPO Dentists |
Out-of-Network Non-DPO Delta Dentists |
Non-Delta Dentists |
Your out-of-pocket expense will probably be less because DPO dentists have agreed to charge DPO patients reduced fees.
You may be charged only the patient share at the time of treatment, not Delta's portion. |
You will be charged no more than the fees approved by Delta as customary and reasonable
You may be charged only the patient share at the time of treatment, not Delta's portion. |
You will be responsible for the dentist's fees, which may be higher than those approved by Delta.
You may have to pay the entire amount in advance and wait for reimbursement. |
Principal Benefits and Covered Services |
When treatment is provided by... |
An In-Network Dentist |
An Out-of-Network Dentist |
Who's covered |
Primary enrollee, Spouse, Eligible Dependent children to age 24* |
Primary enrollee, Spouse, Eligible Dependent Children to age 24* |
Deductibles and Benefits Maximum |
$0 per person, $0 per family per calendar year.
The maximum benefit paid per calendar year is $2,000 per person |
$50 per person, $150 per family per calendar year. (No deductible applies if a DPO dentist is used)
The maximum benefit paid per calendar year is $500 per person |
Diagnostic and Preventive Benefits* |
100% of DPO approved |
50% of Delta approved |
Basic Benefits* |
100% of DPO approved fee |
50% of Delta approved fee |
Crowns, Jackets and Cast Restorations |
100% of DPO approved fee |
50% of Delta approved fee |
Prosthodontic Benefits* |
50% of DPO approved fee
(Subject to a maximum allowance) |
50% of Delta approved fee
(Subject to a maximum allowance) |
Accident Benefits |
100% of Delta Dentists' approved fee limited to a separate $1,000 maximum per person, per calendar year |
100% of Dentists' approved fee limited to a separate $1,000 maximum per person, per calendar year |
*Eligible dependent children age 0 – 19 must be unmarried and claimed as a dependent by the member. Eligible dependent children age 19-24 must be unmarried, claimed as a dependent by the member and in school full time (12 units) at an accredited college or university. |