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Delta Dental DPO

Dental Plan Option 

Delta Dental
800-765-6003
Group Number 424

Dental benefits are another important element of your overall health. With proper care, your teeth can and should last a lifetime. Santa Clara University provides comprehensive dental care for employees and their eligible dependents.

DELTA DENTAL PLAN HIGHLIGHTS

IN-NETWORK

OUT-OF-NETWORK (1)

General Information

When you obtain dental services from network providers, you will receive higher coverage.

You may receive dental care from any dentist you wish. If you receive care from non-network dentists, your coinsurance will be higher.

Annual Deductible

Waived for Preventive Care Services

Individual

$25

$25

Family

$75

$75

Annual Maximum Benefit

$3,500

$3,500

Preventive Services

 

X-rays; Cleanings; Examinations

Eligible Charges
Covered at 100%

Eligible Charges
Covered at 100%

Routine Basic Services

 

Amalgam Fillings; Extractions; Root Canals

Eligible Charges
Covered at 100%

Eligible Charges
Covered at 80%

Major Services

 

Bridges; Dentures; Crowns, Implants

Eligible Charges
Covered at 60%

Eligible Charges
Covered at 50%

Orthodontia Services (employee, spouse/domestic partner, and dependent children to age 26 only)

 

Eligible Charges Covered at 50%, up to a Lifetime Maximum of $3,000

Eligible Charges Covered at 50%, up to a Lifetime Maximum of $3,000

(1)  Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and the program allowance for no-Delta Dental dentists.