Delta Dental of California
1-888-DELTA-CS
(1-888-335-8227)
Group #: 4224-0005,
COBRA Group #: 4224-0006
Website: www.deltadentalca.org
Who is Eligible?
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All exempt employees and non-exempt employees are required to enroll and will become eligible to receive Benefits on the first day of the month coincident with or next following their date of hire.
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Faculty members under Phased Retirement and faculty members on loan to others universities are also eligible under this plan.
Your Co-Payments, Deductibles and Maximums
| Dental Services | DPO Dentist | Non-DPO Dentist | Calendar Year Maximum | Calendar Year Deductible | Waiting Periods |
| Delta's Co-Pay | Your Co-Pay | Delta's Co-Pay | Your Co-Pay |
| Diagnostic and Preventive Services | 100% | 0% | 100% | 0% | $2,000 for each Enrollee | You must pay the first $25 of Covered Services for each Enrollee in your family in each calendar year except for Diagnostic and Preventive Benefits, up to a limit of $75 per family. | None |
| Basic Services | 100% | 0% | 80% | 20% | None |
| Crowns, Jackets, Inlays, Onlays, and Cast Restorations | 60% | 40% | 50% | 50% | None |
| Prosthodontic Services | 60% | 40% | 50% | 50% | None |
| Orthodontics for dependent children only | 50% | 50% | 50% | 50% | $2,500 lifetime Maximum for each child | None |
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