The following plan descriptions are provided to assist you in selecting a dental plan. Please consult each dental plan’s Evidence of Coverage available on their websites for detailed information and plan limitations.

Prepaid (DHMO) Dental Plans

DeltaCare USA, MetLife^[1], Premier Access and Western Dental provide dental services through member/participating dentists throughout California. Dental implant services are offered by Premier Access and Western Dental only. All prepaid (DHMO) dental plans have continuation of orthodontic care if you decide to change dental plans while orthodontic treatment is in progress.

You must enroll with a participating dentist or you will be assigned to a dental provider by the dental plan. You may change dentists upon request and/or change dental plans if you move and there is no participating dental provider in your area. The state-sponsored prepaid dental plans are not available outside of California.

Enrollees in these plans have no maximum annual benefit limits. Many services are provided at minimal or no cost to you. Before you enroll in a prepaid plan, first check with the plan to make sure there are member dentists in your area.

Please note that the MetLife Enhanced plan is not available for represented employees.

Indemnity and PPO Dental Plans

Delta Dental offers two plans: Delta Dental PPO plus Premier and the Delta Dental Preferred Provider Option (PPO). Both plans are briefly summarized below.

Delta Dental PPO plus Premier

Delta Dental PPO plus Premier features full access to specialty care and guaranteed benefits through in-network dentists. Your current dentist may be a member of Delta Dental PPO or Delta Dental PPO plus Premier. It is to your advantage to select an in-network dentist for better and lower out-of-pocket costs to you. A lower percentage of the dentist’s billed fees may be covered by this program if you select a dentist who does not contract with Delta Dental. However, you can see any dentist throughout the United States and abroad and still be covered.

Delta Dental contracted dentists submit your treatment authorizations and claim forms to Delta Dental for reimbursement. If you receive services from a non-participating dentist, your reimbursement will be based on the fee charged by that dentist or the fee that satisfies the majority of Delta Dental’s participating dentists, whichever is less. Services provided by a non-participating provider may result in higher out-of-pocket costs for you. You can be reimbursed by submitting either an itemized receipt or a standard claim form to Delta Dental. Reimbursement for services provided by non-participating dentists will be paid directly to you.

Please note that the Delta Dental PPO plus Premier Enhanced plan is not available for represented employees.

Delta Dental Preferred Provider Option (PPO)

The PPO provides higher benefits levels for you and your dependents when you receive services from an in-network PPO provider. Your costs are based on a discounted fee agreement between Delta Dental and the PPO provider. This fee agreement will result in lower out-of-pocket costs to you when you visit an in-network PPO dentist. PPO network dentists submit your treatment authorizations and claim forms to Delta Dental for reimbursement.

Although you can receive services from any dentist throughout the United States and abroad, if you receive services from a dentist who is not an in-network PPO dentist, your coverage will be reduced, and you will be responsible for higher out-of-pocket fees. Any reimbursement for services provided by non-Delta dentists will be paid directly to you. Before you enroll in the PPO plan, first check with the plan to make sure there are in-network and contracted dentists in your area.

COBRA Carrier Contact Information for State-Sponsored Dental Plans

Delta Dental of California

Isolved Benefit Services
P.O. Box 737937
Dallas, TX 75373-7937
(866) 594-6957
www.deltadentalins.com/state

DeltaCare USA
Isolved Benefit Services
P.O. Box 737937
Dallas, TX 75373-7937
(866) 594-6957
www.deltadentalins.com/state

Support for COBRA enrolled members
Participants: (800) 594-6957
Employees: (866) 320-3040
Email: crmail@isolvedhcm.com
Email: IsolvedCobra@delta.org

MetLife^[2]

ATTN: SOC COBRA Billing
P.O. Box 13724
Philadelphia, PA 19101-3724
(800) 880-1800
www.metlife.com/safeguard/soc

Premier Access
8890 Cal Center Drive
Sacramento, CA 95826
(888) 534-3466
www.socdhmo.com

Western Dental
ATTN: Group Services Department
530 South Main Street
Orange, CA 92868
(866) 859-7525

www.westerndental.com/state-of-ca

[1] Dental benefits provided by SafeGuard Health Plans, Inc., a MetLife company

[2] Dental benefits are provided by SafeGuard Health Plans, Inc., a MetLife Company

The premiums shown below are 102% of current total premiums.

STATE-SPONSORED DENTAL PLANS

Delta Dental

DeltaCare USA

MetLife

Premier Access

Western Dental

Employees in BU6 should contact the California Correctional Peace Officers Association (CCPOA) Benefits Trust Fund at (916) 779-6300 or (800) 468-6486.