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Dental Coverage

Dental Coverage

Clovis Unified School District offers two dental plan through Delta Dental of California for full-time & eligible part-time employees, dependents, and eligible retirees covered under the Plan.

Due to the composite rate structure of the Plan, there is no difference in cost beween the two plans. Each dental plan offers different levels of coverage & should be chosen based on member utilization. The plan year for dental coverage runs from January 1st through December 31st.

Below is a brief description of the benefit provisions for each dental plan. For a breakdown about the differences between the plans, see the Comprehensive Plan Comparison & Out-Of-Network Benefits – PPO vs Premier under Resources for more information.

 

A graphic with a red tooth and a profile icon, along with text that says 'Access the Delta Dental Website and search for providers in the PPO & Premier networks.' There is also a phone icon and text that says 'For questions about your dental coverage, please contact Delta Dental. Toll-Free Member Services: 866-499-3001.'

 

  • The Delta PPO Plan is a Preferred Provider Program that provides the maximum benefit when you visit a dentist within the PPO network.

    PPO dentists charge reduced fees for services rendered to PPO patients due to the potential to receive more from the patient's annual maximum allowable benefit.

    See the Comprehensive Plan Comparison & Out-Of-Network Benefits – PPO vs Premier under Resources for more information.

  • The Delta Premier Plan is an incentivized program that starts off paying 70% of the approved fees for covered diagnostic, preventative, basic, and cast & crown benefits during the first year of eligibility. This percentage will increase by 10% each year – to a maximum of 100% – for each enrollee, provided that the enrollee visits the dentist at least once per plan year.

    If an enrollee does not use the program during the plan year, the percentage of coverage will remain at the level reached during the previous plan year.

    If an enrollee becomes ineligihle for benefits & later regains eligibility, the percentage will start back at 70%.

    See the Comprehensive Plan Comparison & Out-Of-Network Benefits – PPO vs Premier under Resources for more information.

  • Although both dental programs cover many of commonly needed services, some services are not covered. If you are unsure whether a particular service or procedure is covered and/or how much of it is paid for by your Delta Dental plan, call Delta Dental of California Member Services before proceeding.
     
    The following are not covered by the programs:

    • Services for injuries or conditions covered under Workers’ Compensation or Employer’s Liability Laws
    • Cosmetic surgery, dentistry, or services to correct congenital malformation
    • Experimental procedures
    • Therapeutic drugs, premedication, or pain relievers
    • Hospital costs or extra charges for hospital treatment
    • Anesthesia (except for general anesthesia for oral surgery)
    • Extra-oral grafts, implants, and implant removal
    • Treatment related to the temporomandibular joint (TMJ)
    • Orthodontic treatment

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The preceding information is not intended for use as a summary plan description, nor is it designed to serve as an evidence of coverage for the programs.  To use your Delta Premier plan or your Delta PPO plan, just call the dental office of your choice and make an appointment. During your first appointment, give your dentist your group number and the primary enrollee’s social security number.  If you have specific questions regarding benefit structure, limitations or exclusions, consult the evidence of coverage or contact Delta Dental's Member Services toll free at 866-499-3001.

 

DELTA DENTAL PLAN OF CALIFORNIA
P.O. BOX 7736
SAN FRANCISCO, CA 94120