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Dental

Delta Dental
(800) 765-6003

 

Dental Plan Option

Using the Plan

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 dental care coverage through Delta Dental. Under this plan, you may receive care from any dentist you wish. If you obtain dental care services from a dentist who participates in the Delta Preferred Option (DPO) network, you may have the opportunity to save money. 

Dentists participating in the Delta Preferred Option network agree to discount their charges, and benefits are based on discounted fees. You may locate a participating dental provider or call (800) 765-6003.

You also have the option of obtaining dental care services from dentists who do not participate in the DPO network. Since the fees for Non-DPO dentists are not discounted (as they are with network providers), your out-of-pocket expenses may be greater.

PLAN HIGHLIGHTS

DELTA DENTAL

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

$2,000

$2,000

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 (children to age 26 only)

 

Eligible Charges Covered at 50%, up to a Lifetime Maximum of $2,500

Eligible Charges Covered at 50%, up to a Lifetime Maximum of $2,500

(1)                   Payment to provider based on reasonable and customary rates