Dental Plan



Delta Dental Plan of California DeltaPreferred Option Plus (Plan B)

CALENDAR YEAR DEDUCTIBLE	In-Network	Out-of-Network
$50 Single / $150 Family on Class I and Class II benefits. Deductible does not apply to services covered at 100% or Class III benefits.
MAXIMUM BENEFIT
$1,000 on Class I and Class II benefits. Class III will not exceed a lifetime maximum of $1,000 per eligible person.
CLASS I
Diagnostic & Preventive Emergency Palliative Treatment Radiographs Oral Surgery Minor Restorative Services Periodontics Endodontics	No charge No charge No charge No charge No charge No charge No charge	No charge No charge No charge No charge 80% after deductible 80% after deductible 80% after deductible
CLASS II
Prosthodontics Major Restorative Services	60/40% 60/40%	50/50% 50/50%
CLASS III
Orthodontics (to age 19)	50/50%	50/50
This chart is only a summary. Please see the evidence of coverage or disclosure form for the selected plan for a thorough description of its benefits, limitations, exclusions and conditions of coverage.

Customer Service Information
CARRIER INFORMATION
Carrier website Find a Dentist Customer Service Forms	http://www.deltadentalca.org/ http://www.deltadental.com/search.asp http://www.deltadental.com/GeneralServiceInquiry2.asp Enrollment/Change Form
CLAIMS INFORMATION
Claims address Claims phone number
BROKER INFORMATION
Broker phone number Broker email address

FAQs - Frequently Asked Questions :

Q : Where can I get information about my benefits ? A : To better understand your Delta coverage, review the plan materials you received after you were enrolled. DeltaCare enrollees : Please call PMI at 1(800) 422-4234 as online summaries are not yet available. Q : How do I obtain information about fees for treatment ? A : Talking with your dentist should help you understand your financial responsibility. Your dentist knows his or her approved fees and has easy access to your individual coverage information. Many patients are reluctant to ask their dentist for this information, but your dental office will probably welcome the opportunity to discuss fees and your share of the cost. • Keep in mind that Delta's payment varies depending on : The dentist you select : Most Delta programs allow you to choose any dentist, and every Delta dentist has a different set of approved fees on file for each service. Under most Delta programs, you will have a certain percentage of coverage (for example, 80 percent coverage for diagnostic and preventive services such as cleanings and x-rays). One dentist might charge $50 for a procedure and another might be approved to charge $75. While the coverage would always be 80 percent, the dollar amount of the coverage and your copayment (the remaining 20 percent) will depend on the dentist you visited. The program you're enrolled in : Some Delta programs, usually our DeltaPreferred Option (DPO) programs, offer a higher level of coverage if you select an in-network dentist. Others offer a higher level of coverage if you regularly visit the dentist. Some Delta programs, usually our DeltaPremier table of allowance programs, cover a certain dollar amount for each procedure. You pay the difference between the table amount and your dentist's approved fee. (In this case, your employer will give you a list of the amounts Delta will pay for each procedure.) Other programs, usually DeltaCare programs from Delta dental HMO affiliate, PMI Dental Health Plan, specify the dollar amount you will pay for each service. You receive a list of these services and copayments and you select the PMI dentist who will provide primary care for you and your family. Q : My dentist says I need three crowns and it sounds like it will be pretty expensive. Do I need to get preapproval from Delta ? A : A few Delta programs require preapproval for treatment expected to exceed $200-$300. However, whether or not your program requires it, it is a good idea to know exactly what your share of the cost will be before you receive treatment. Delta can give you a free estimate, called a "predetermination" based on your records and your dentist's proposed treatment plan. Delta will review your x-rays, diagnosis and coverage, and send a statement back to your dentist detailing what Delta will pay, and what your costs will be. Q : I am covered by Delta both through my own employer and my spouse's. Does this mean I now get four cleanings a year instead of two ? A : Having two dental programs (called "dual coverage") does not "double" your coverage. However, it may mean that you will pay lower out-of-pocket costs. One program will be considered primary (the one through your work), and the other will be secondary (the one through your spouse's job). If you have children, primary coverage for them is usually determined by the parent whose birthday (month and day, not year) comes earlier in the year. Say both you and your spouse's dental programs cover 80 percent for cleanings. Usually, your program would cover the first 80 percent, and your spouse's program would cover the remaining 20 percent. But your spouse's program may have a non-duplication of benefits rule. This means the second program would pay only if the first program paid less than the second would have paid. In this case, the total benefit would be limited to 80 percent. You are responsible for paying the remainder.

Selecting a Dentist :

Q : How do I find a Delta dentist or check to see if my current dentist is a Delta dentist ? A : We offer an online dentist directory on our web site. Click here to access the directory. Q : What are the advantages of visiting a Delta dentist ? A : When you visit a Delta dentist : • You do not pay the entire bill and wait for reimbursement from Delta. Instead, Delta pays its portion directly to your dentist. We send you a notice explaining your portion of the bill. You pay the dentist only that amount. • Your costs may be lower because Delta dentists agree to charge you fees they have negotiated with us. If you are responsible for a 20 percent copayment, you pay 20 percent of your dentist's approved fee. Also, Delta makes sure you are not charged extra for services that should be included in the cost of treatment. For example, when you receive a crown, you cannot be charged additional fees for tooth preparation, local anesthesia, an impression or a temporary crown. • The dentist handles all claim forms and other paperwork for you. Q : My dentist is not a Delta dentist. Can I still visit him or her ? A : Most Delta programs allow you to select any licensed dentist. We recommend you select a Delta dentist because you may enjoy lower out-of-pocket costs and the convenience of having your claim forms handled free-of-charge by the dental office. Be aware that if you are enrolled in the DeltaPreferred Option (DPO) program, which is Delta's preferred provider organization (PPO) program, you will probably have lower costs if you select a Delta dentist who participates in that program. Be sure to select that option when you use the dentist directory online. If you are enrolled in DeltaCare, which is the dental HMO program administered by PMI Dental Health Plan, you must receive treatment from your primary care PMI dentist. Treatment provided by another dentist, even if he or she participates with the DeltaCare program, will usually not be covered, unless the dentist is a specialist referred by your assigned primary care dentist. Q : How do I know Delta dentists provide quality treatment ? A : All dentists accepted for Delta membership must meet professionally recognized quality standards. They must provide information on equipment, radiation safety, cleanliness, patient treatment plans and other elements of their dental practice. If you are unhappy with the care you receive from a Delta dentist, Delta can arrange for you to be examined by one of our consulting dentists in your area. If the consultant feels the work must be corrected, Delta will intervene with the original dentist to either have the work redone at not additional cost to you or obtain a refund. In the latter case, you're free to choose another dentist to have the treatment corrected. Q : How do I change dentists ? A : Most Delta programs allow you to see any dentist you wish, and there is no need to notify us when you change. You and your family members are also free to see different dentists if you prefer. If you are enrolled in a DeltaCare program from Delta dental HMO affiliate PMI Dental Health Plan, changing dentists can be done by simply completing and submitting the online Customer Relations Request form. Transfers are usually effective the first day of the following month. Q : I know my dentist is a Delta dentist ?      Why doesn't he show up on your online directory ? A : You most likely searched for dentists in your city or ZIP code, without specifying the name of your dentist in your search. When you don't specify a name, the directory locates up to 100 dentists (randomly selected) who meet your search criteria. Try entering your dentist's last name into your search. • Other reasons your dentist may not be showing up in your search : Your dentist may be a specialist. The default search is for a general practictioner, but you can change this by using the pull-down menu in the search. Your dentist may not practice in the town or ZIP code that you specified. Try using only the first three digits of the ZIP code to broaden your search. Your dentist may be a Delta dentist, but may not participate in the DeltaPreferred Option or DeltaCare network. If that's true, his or her name would not appear in those searches, but will appear in a search of DeltaPremier dentists. Your dentist may have recently joined Delta (the directory is updated monthly), or may have recently left. Check with your dentist to be sure.

Paperwork :

Q : I wasn't issued an ID card when I enrolled. Why ? A : Since ID cards are not actually necessary to receive treatment, many employers do not provide dental ID cards for employees enrolled in Delta programs. When visiting a dental office, you simply need to provide your social security or identification number and the office can use that information to verify your eligibility and benefits with Delta. Q : I need to change my address. Where can I submit this information ? A : Delta normally uses the address submitted by your dentist on your most recent claim form, so make sure that your dentist has your current address. Delta may also obtain your address from your employer or program sponsor. Delta mails the Notice of Payment or Action (a statement explaining what services the dentist provided, the amounts Delta will pay and the amount you are responsible for paying) to the primary enrollee, who is the person with the dental coverage. Q : I've recently married. How do I add my new spouse to my plan ? A : Delta receives the information about covered family members from your employer, union or other group sponsor. Please follow the procedures at your company to add, delete or change information about covered family members. Q : Where can I obtain claim forms ? A : One of the advantages of visiting a Delta dentist is that you do not need claim forms. Delta dentists will take care of all claims paperwork for you. If you go to a non-Delta dentist -- for example, if you are traveling outside the country and need to see a dentist -- you can download a claim form.

About Delta :

Q : How much of my premiums actually go to dental care, and how much go to shareholder profits ? A : Delta is a nonprofit healthcare service corporation, not an insurance company, so there are no shareholders and no profits. Eight cents of every premium dollar goes to cover administrative expenses such as claims adjudication, fraud control and computer systems. The other 92¢ pays for dental services. Q : I don't live in California. Should I still be using the Delta Dental Plan of California web site ? A : Yes, if your benefits coverage is provided through Delta Dental Plan of California or PMI Dental Health Plan (Delta's dental HMO affiliate), this web site was designed for you. Your group administrator will probably know whether Delta Dental Plan of California or some other Delta Plan administers your coverage. If you are covered through the TRICARE Retiree Dental Program for members of the Uniformed Services, please visit our special web site for that program at http://www.ddpdelta.org. Q : I have been hearing a lot about protecting patient rights lately, especially in the HMO world. What's Delta's position on this ? A : Long before the current political debate over managed care, we established a commitment to protecting patient rights. We believe that you, as a Delta enrollee, have the right to expect quality, affordable care that protects not only your dental health, but also your privacy and ability to make informed choices. We also believe that you have certain responsibilities to help protect these rights. Please review our patient rights and responsibilities statement. Q : Where can I obtain claim forms ? A : One of the advantages of visiting a Delta dentist is that you do not need claim forms. Delta dentists will take care of all claims paperwork for you. If you go to a non-Delta dentist -- for example, if you are traveling outside the country and need to see a dentist -- you can download a claim form.

Special Programs :
	Q : Where can I find information about the program for military retirees ? A : Please visit our special web site for the TRICARE Retiree Dental Program.