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%.
Refer to the Benefits Compliance Documents web page for a summary of benefits and evidence of coverage.
IMPORTANT: Review the comparative costs of visiting an in-network dentist versus an out-of-network dentist.
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 | $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.
- Web: www.deltadentalins.com
- Phone: 800-765-6003
- Group no.: 02406