Earn 40,000 bonus miles and 5,000 Medallion Qualification Miles (MQMs) after you spend $2,000 in eligible purchases on your new Delta SkyMiles® Platinum American Express Card within your first 3 months. DeltaCare® USA DENTAL COMPARISON CHART Effective September 1, 2019 State of Texas Dental Choice This is a preferred provider organization (PPO) dental insurance plan. Password? You must be a resident of California to enroll. Open Enrollment Information and Comparison Guide 4 2019 Employee Benefits PLAN NAME DELTA DENTAL Premier Plan (PPO) DELTACARE - PLAN (HMO) MEMBER SERVICES Participating Dentist PLAN PAYS: Non-Participating Dentist Plan pays up to 70% of maximum plan allowance: FEE CROWNS AND BRIDGES: (4): CROWNS - PER UNIT 70% Up to 70% No Cost The DeltaCare USA network consists of private practice The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. There are no yearly maximums or deductibles. Plus, earn a $100 statement credit after you make a Delta purchase with your new Card within your first 3 months. Refer to your group contract to determine if this coverage is included with your plan. When you enroll in a DeltaCare USA1 plan, you’ll choose a primary care dentist from our network of carefully screened, private practice dentists. DeltaCare ® USA (Dental HMO; California residents only) This plan provides comprehensive benefits and easy referrals to specialists. DeltaCare USA Plan 11A (Spanish).pdf . Are pre-existing dental conditions and treatment-in-progress covered? DeltaCare USA DHMO, focuses on maintaining oral health, prevention and cost containment. Plan Benefits. (Some orthodontists may refer patients to labs specializing in orthodontic x-rays for specific photos.) Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis. Enrollees must enter their location and select the DeltaCare USA network from the drop-down menu. How do enrollees begin orthodontic treatment? Most basic services are covered at no cost. All x-rays must be performed by the orthodontist. Most basic services are covered at no cost. Enrollees can read this Plan CAD48 DeltaCare USA Description of Benefits and Copayments SCHEDULE A Description of Benefits and Copayments The Benefits shown below are performed as deemed appropriate by the attending Contract Dentist subject to the limitations and exclusions of the Program. How do enrollees select or change their general dentist? © Delta Dental This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. DeltaCare USA, Premier Access, SafeGuard, and Western Dental The prepaid plans require you and your eligible dependents to use a dentist from a specific list of dentists who are located in California and who contract with your selected prepaid carrier. Main page content Document File(s) DeltaCare Benefits Guide. † $250 Annual Fee. If enrollees cannot reach their network dentist or DeltaCare USA customer service for a referral, they may use their out-of-area emergency benefit (typically limited to $100 per emergency, subject to standard plan limitations and exclusions; copayments may apply). Refer to your group contract for full details). Read more + less - Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. Manage your enrollment and view eligibility and benefits. These networks are generally quite small. Created with Sketch. DeltaCare USA is a managed dental care plan. THE COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM AND THE PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. enrollees web page and give it directly to their orthodontist. Dentists receive a … Enrollees must receive care from their selected/assigned primary care dentist within the DeltaCare USA network. DeltaCare USA Continuous Orthodontic Coverage form29 KB from the Delta Dental However, benefits are not provided for any dental treatment started before joining the program (that is, work in progress, such as preparations for crowns, root canals and impressions for dentures). Enrollees should discuss all treatment options with … Their copayments, limitations and exclusions are determined by the group contract.*. At the time of service, enrollees pay the dentist only the listed copayment (found in their plan booklet) for covered services. DeltaCare ® USA plan. Box 1803 Alpharetta, GA 30023 800-471-9925 deltadentalins.com CoveredCA.com 800 … DeltaCare® USA Dental benefits the easy way Underwriter Delta Dental of California 17871 Park Plaza Drive, Suite 200 Cerritos, CA 90703 Claims and Correspondence P.O. DELTACARE USA Managed care option—all dental care must be coordinated through your network dentist DELTA DENTAL PPO To receive the highest level of benefits, use Delta Dental PPO dentists NATIONWIDE NONE KNOW YOUR OPTIONS BEFORE YOU CHOOSE GLOSSARY — Here’s a key to the abbreviations you’ll see throughout this summary chart. DeltaCare USA plan features •No deductibles, no Clearly defined copayments • No annual deductibles and no maximums • Low or no costs for many services such . In Florida, Delta Dental Insurance Company provides DeltaCare USA Plan benefits as a Prepaid Limited Health Service Organization as described in Chapter 636 of the Florida Statutes. Box 1810 Alpharetta, GA 30023. 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