2026 Dental and Vision Plan Deduction Codes and Premiums
Dental and Vision Plan Deduction Codes and Premiums
The following tables show premiums for the specified plan year. For employees in CoBen, the state share and employee share do not apply and the total dental premium will be deducted from the monthly CoBen allowance.
2026 Dental and Vision Plan Deduction Codes and Premiums
State Sponsored Dental Plans
Delta Dental PPO plus Premier Basic Plan—Represented Employees
Group Number: 9949-0101
Dental Org. Code: 351-007
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$36.98 |
$12.33 |
$49.31 |
|
Party Code 2 |
$64.58 |
$21.52 |
$86.10 |
|
Party Code 3 |
$93.33 |
$31.11 |
$124.44 |
Delta Dental PPO plus Premier Enhanced Plan—Excluded Employees
Group Number: 9949-2101
Dental Org. Code: 351-008
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$0.00 |
$51.29 |
$51.29 |
|
Party Code 2 |
$0.00 |
$100.95 |
$100.95 |
|
Party Code 3 |
$0.00 |
$141.81 |
$141.81 |
Delta Dental Preferred Provider Option (PPO)—Excluded and Represented Employees
Group Number: 9946
Dental Org. Code: 351-018
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$33.80 |
$11.26 |
$45.06 |
|
Party Code 2 |
$65.71 |
$21.90 |
$87.61 |
|
Party Code 3 |
$98.87 |
$32.95 |
$131.82 |
Prepaid Dental Plans – State Pays 100%
DeltaCare USA
Group Number: 72003
Dental Org. Code: 351-009
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$19.44 |
$0.00 |
$19.44 |
|
Party Code 2 |
$31.90 |
$0.00 |
$31.90 |
|
Party Code 3 |
$44.13 |
$0.00 |
$44.13 |
MetLife Standard Plan*
Group Number: 74503
Dental Org. Code: 351-016
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$13.85 |
$0.00 |
$13.85 |
|
Party Code 2 |
$22.44 |
$0.00 |
$22.44 |
|
Party Code 3 |
$31.42 |
$0.00 |
$31.42 |
MetLife Enhanced Plan*
Group Number: 74503
Dental Org. Code: 351-015
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$16.06 |
$0.00 |
$16.06 |
|
Party Code 2 |
$27.18 |
$0.00 |
$27.18 |
|
Party Code 3 |
$33.48 |
$0.00 |
$33.48 |
Premier Access
Group Number: 12700
Dental Org. Code: 351-020
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$14.21 |
$0.00 |
$14.21 |
|
Party Code 2 |
$23.02 |
$0.00 |
$23.02 |
|
Party Code 3 |
$32.24 |
$0.00 |
$32.24 |
Western Dental
Group Number: 2140352
Dental Org. Code: 351-025
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$15.77 |
$0.00 |
$15.77 |
|
Party Code 2 |
$26.02 |
$0.00 |
$26.02 |
|
Party Code 3 |
$36.91 |
$0.00 |
$36.91 |
Union Sponsored Dental Plans
CAHP/Blue Cross (R05)
Group Number: 336817-A
Dental Org. Code: 351-013
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$36.98 |
$25.83 |
$62.81 |
|
Party Code 2 |
$64.58 |
$45.04 |
$109.62 |
|
Party Code 3 |
$93.33 |
$66.67 |
$160.00 |
CCPOA/ Dental (R06)
Group Number: Fee-For-Service
Dental Org. Code: 351-006
|
Party Code |
State Share |
Employee Share |
Total Premium |
|
Party Code 1 |
$69.06 |
$0 |
$69.06 |
|
Party Code 2 |
$69.06 |
$0 |
$69.06 |
|
Party Code 3 |
$69.06 |
$0 |
$69.06 |
CCPOA/ Dental (S06, M06, E06, C06)
Group Number: Fee-For-Service
Dental Org. Code: 351-246
|
Party Code |
Total Premium |
|
Party Code 1 |
$31.49 |
|
Party Code 2 |
$67.24 |
|
Party Code 3 |
$114.91 |
State Sponsored Vision Plans
VSP Basic Plan
Group Number: 30052011
Vision Org. Code: 475-001 (Non–CoBen) or 475–002 (CoBen)
|
Party Code |
State Share |
Employee Share |
Total Premium (CoBen) |
|
Party Code 1 |
$8.10 |
$0 |
$8.10 |
|
Party Code 2 |
$8.10 |
$0 |
$8.10 |
|
Party Code 3 |
$8.10 |
$0 |
$8.10 |
VSP Premier Plan
Group Number: 30034581
Vision Org. Code: 361-475
|
Party Code |
State Share |
Employee Share |
Total Premium (CoBen) |
|
Party Code 1 |
$8.10 |
$8.63 |
$16.73 |
|
Party Code 2 |
$8.10 |
$17.09 |
$25.19 |
|
Party Code 3 |
$8.10 |
$27.41 |
$35.51 |
2025 Dental and Vision Plan Deduction Codes and Premiums
Access the 2025 Dental and Vision Plan Deduction Codes and Premiums here.
Carrier Contact Information for State-Sponsored Dental and Vision Plans
Delta Dental of California
P.O. Box 997330
Sacramento, CA 95899-7330
(800) 225-3368
www.deltadentalins.com/state/
DeltaCare USA
P.O. Box 1803
Alpharetta, GA 30023
(800) 422-4234
www.deltadentalins.com/state/
MetLife*
P.O. Box 14410
Lexington, KY 40512-4401
(800) 880-1800
www.metlife.com/safeguard/soc/
*Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.
Premier Access
8890 Cal Center Drive
Sacramento, CA 95826
(888) 534-3466
www.socdhmo.com
Western Dental Benefits Division
530 South Main Street, 1st Floor
Orange, CA 92868
(866) 859-7525
www.westerndental.com/state-of-ca
VSP Vision Care
3333 Quality Drive
Rancho Cordova, CA 95670
(800) 400-4569
FAX: (916) 389-8304
stateofcaemployee.vspforme.com
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