Delta Dental of California
1-888-DELTA-CS
(1-888-335-8227)
Group #: 4224-0005,
COBRA Group #: 4224-0006
Website: http://www.deltadentalins.com/santaclarauniversity/
Who is Eligible?
-
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.
-
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
|
