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Delta Dental Insurance

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Faculty Association of California Community College

Welcome to Delta Dental

DELTA DENTAL PPO

DELTACARE USA HMO

 

Print Fill Out and Fax to 209-579-0399
Enrollment Form
 
Highlights of Coverage

How The Plan Works

  • PPO
     
  • HMO
     
  • FAMILY COVERAGE
     
  • FULL OR PART TIME
  • Guaranteed ISSUED

 

 
Provider Directory
       HMO SOUTHERN CAL.

      HMO NORTHERN CAL.

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Affordable Group Dental Rates
 

Rates For PPO

Monthly rates

Guaranteed

Two year

One Party

$39.85

Two Party

$71.44

Three Party+

$120.28

 

Rates For HMO

Monthly rates

Guaranteed

Two year

One Party

$18.16

Two Party

$29.97

Three Party+

$44.32

 
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DeltaCare
How your DeltaCare® USA program works:

Your selected contract dentist will take care of your dental care needs.  If you require treatment from a specialist, your contract dentist will handle the referral for you. After you have enrolled, you will receive a membership packet including an identification card and an Evidence of Coverage booklet that fully describes the benefits of your dental program.

 

 How to select a DeltaCare® USA dentist:

You select a dentist from the attached provider list.  DeltaCare® USA dentists pass stringent reviews for quality, access and safety before joining the network.  Delta Dental maintains quality standards by visiting each general dental office regularly.

 

My dentist is a Delta Dental dentist but is not on the list of DeltaCare® USA dentists.  Can I still receive treatment from this dentist?

You must receive treatment from your selected DeltaCare® USA contract dentist.  Please note that Delta Dental dentists are not necessarily DeltaCare® USA dentists

 

Do my family members receive treatment from the same DeltaCare® USA contract dentist?

You and your eligible dependents may receive care from the same contract dentist, or if you prefer, you may collectively select up to a maximum of three individual contract dental facilities.

 

Can I change my contract dentist?

You may change contract dentists by notifying us either by phone (800-422-4234) or in writing, or by visiting our online provider directory web site (www.deltadentalins.com).  If you contact us by the 21st of the month, the change will become effective the first of the following month.

 
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Procedures
Dental Procedures Covered by The HMO
 Listed below are some of the common dental procedures covered by your DeltaCare® USA dental program.  An Evidence of Coverage booklet that fully describes the benefits of your dental program will be sent to you. 

Procedure code

Procedure

Patient Copayment

D0999

Office Visit

No Cost

D0210

X-Rays

No Cost

D1110

Adult cleanings

No Cost

C2140-61

Fillings (Amalgams)

No Cost

D2391-95

Fillings (Resin-based posterior composites)

$55-$85

D2750

Crown (porcelain fused to high noble metal)

$240

D3330

Molar root canal

$250

D4260

Osseous surgery

$280

D4341

Scaling & root planing

$25

D5110-20

Complete denture (upper & lower)

$145

D7111

Simple extraction

No Cost

D7230

Removal of impacted tooth (partially bony)

$70

D8070

Comprehensive orthodontics (child)

$1,700

D9220

General anesthesia (first 30 minutes)

$165

D9940

Occlusal guard

$100

39972

External bleaching (per arch)

$125

 
 
 
 
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Plan Advantages
 
Portable - unlike coverage through an employer, once you have been covered for 2 years this plan will not terminate if you change jobs!
 
 
 
Payment Options - include quarterly,simi annual,and annualy.
 
 
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Underwritten By
  Delta Dental

DeltaCare USA is our prepaid plan that features set copayments, no annual deductibles and no maximums for covered benefits. In most states, enrollees must select a primary care dentist in the DeltaCare USA network from whom they receive treatment as in a traditional DHMO. In some states, DeltaCare USA is offered as an open access plan where enrollees can obtain treatment from any licensed dentist; however, deductibles and maximums may be applied to out-of-network treatment.

 

 
 
 
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Enrollment Form