Dental Plan
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Delta Dental-Retiree Group
P.O. Box 997330
Sacramento, CA
95899-7330
Phone: (800) 765-6003
Website:
www.deltadentalca.org
Retiree Basic Group number: (4063-0001 + SSN)
Retiree Premium Group number: (4063-0014 + SSN)
Dental Coordinator: (916) 874-7977 |
Delta Dental of California
All retirees are eligible to enroll in a dental plan.
Retiree may elect to enroll their spouse, registered domestic partner,
and/or dependent children at the time of retirement or during Open
Enrollment. Spouses, domestic partners, and/or dependent children may
also be added within 30 days of a “Qualified Status change Event.” Once
you have enrolled in a dental plan, that coverage will continue year to
year until you make a change.
For the calendar year, the County contributes $25.00 towards the
premium cost of the Basic Dental Plan for retirees that retired on or before May
31, 2007. Each Special District determines if a premium offset is provided for
their retirees for this benefit. Retirees pay 100% of the cost for
spouse/domestic partner and/or dependent children coverage.
"REMEMBER 30 DAYS"
You must come to the Employee Benefits Office within 30 days
of the date of a qualifying status change event to make a change to your
medical, dental and life insurance. Failure to do so within the 30-day time
frame will result in your inability to make the change until the next Annual
Enrollment period.
Basic Dental Plan
The Basic Dental plan pays benefits based upon a fee schedule. For
specific coverage information for the Basic Dental plan,
click here.
Premium Dental
Plan
This plan provides two levels of benefits:
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If you receive services
from a Delta PPO (formerly called DeltaPreferred Option) in-network dentist,
the plan will pay 60% of the basic, preventative and diagnostic services;
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If you receive services
from a non-PPO Delta dentist, the plan will pay 55% of the basic,
preventative and diagnostic services based upon the Delta Dental Premier
dentists’ allowed fees.
For specific coverage information for the Premium Dental plan,
click here.
Hardcopies of the Evidence of Coverage booklet that contains
details about the plan is also available from the Employee Benefits Office.
Both the Basic and Premium Dental Plan do not coordinate with
itself or each other. Therefore you may only be enrolled in one
County-sponsored retiree dental plan. You may not be enrolled in the Dental
plan as a retiree and as a beneficiary or as a spouse of another retiree.
Children may only be enrolled as dependents of one retiree.
A list of DeltaPreferred Option Dentists and Delta Dentists can be
obtained by calling 1-800-765-6003 or logging onto to Delta Dental’s website at
www.deltadentalca.org. This list will identify those dentists who can
provide care for individuals who have mobility impairments or have special
health care needs.
Inquire about the availability of documents in
alternate formats.
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