Delta Dental
USF offers a dental PPO plan through Delta Dental of California, giving you the freedom to visit any in-network or out-of-network dentist you choose. You may be liable for higher out-of-pocket expenses if the dentist is not in the Delta Dental network.
This incentive plan rewards employees for going to the dentist at least once a year. During the first year, the Delta Dental plan pays 70%1 of the cost for many dental services up a maximum of $1,7502 per calendar year, per participant. This percentage will increase by 10% each year if you see a dentist at least once a year, until it reaches 100%. If you do not use the plan for a year, this percentage remains the same as the year before. If you and/or your Dependents lose your plan benefits and then get them back, the percentage will be reset to 70%.
IMPORTANT: Review the comparative costs of visiting an in-network dentist versus an out-of-network dentist.
You can search for in-network providers at https://www1.deltadentalins.com/find-a-dentist-members.html. Please log in to your Delta Dental online account before searching for the most accurate results. Select the 'Delta Dental PPO' or Delta Dental Premier' network. Please note that going to a Delta Dental Premier dentist will be more expensive. It is recommended to confirm if a provider remains in-network before receiving services. For any coverage or claims questions, please contact Delta Dental directly.
Refer to the Benefits Compliance Documents web page for a summary of benefits and evidence of coverage.
1 Delta Dental out-of-network claims are reimbursed at the 80th percentile of the Usual, Customary and Reasonable (UCR) reimbursement rate. The incentive plan still applies.
2 Calendar year dental plan maximum is $1,500 for USFFA members per their Collective Bargaining Agreement (CBA).
The claim example below assumes that you have satisfied the incentive plan and your coverage is at 100% for the treatment received.
fee | delta dental ppo dentist | non-delta dentist |
---|---|---|
Example: Dentist charges for a crown | $1,000 | $1,000 |
Accepted Fee |
$600 (example Accepted Fee, not actual) |
$1,000 |
Reimbursement allowed by plan (Maximum Permitted Allowance, MPA) | $600 |
$750 (example MPA, not actual) |
Reimbursement based on | PPO fee |
80th percentile of UCR* |
Delta Dental plan pays |
$600 | $750 |
Member pays |
$0 | $250 |
Plan savings | $600 savings to member | -$250 cost to member |
*Percentiles are calculated by ranking a set of given fees in your area from lowest to highest. On a list of 10 given fees, the eighth ranked fee would be considered the 80th percentile.
You can register for a Delta Dental online account at deltadentalins.com/login.
- Web: www.deltadentalins.com
- Phone: 800-765-6003
- Group no.: 02406