PPO Low Plan
A lower-cost dental plan without orthodontia coverage.
2024 dental plans
You can enroll in the dental plan of your choice as a new hire, during Open Enrollment, or if you have a qualifying life event. To see your contributions and enroll, log in to Workday.
PPO Standard High Plan (Buy-up)
A dental plan with higher benefits, a higher calendar year maximum, and coverage for orthodontia.
Key features at a glance
Our dental coverage provides:
Free in-network preventive and diagnostic care
to help keep your teeth healthy
Coverage for a wide range of services
to help you manage the cost of dental treatment
Large network of providers
that have agreed to negotiated rates, which helps you save money
Find a network dentist
You may choose to see any in- or out-of-network dentist you’d like, but you’ll generally pay less when you stay in network. Out-of-network providers will typically have higher rates (costs) than those in-network, and if you choose to go out-of-network you will most likely need to pay up front then file a claim for reimbursement. Visit the Delta Dental website to find an in-network provider near you.
Coverage details
| Coverage for in-network & out-of-network* | PPO Low Plan | PPO Standard High Plan |
|---|---|---|
| Calendar year deductible | Individual: $50 Family: $100 |
Individual: $50 Family: $100 |
| Calendar year maximum benefit | $1,000 (including Class I expenses) | $5,000 (Class I expenses do not apply) |
| Services | ||
| Class I Expenses: Preventive & Diagnostic Care | You pay $0, plan pays 100% (no deductible) | You pay $0, plan pays 100% |
| Class II Expenses: Basic Restorative Care | You pay 20%, plan pays 80% (after deductible) | You pay 20%, plan pays 80% (after deductible) |
| Class III Expenses: Major Restorative Care | You pay 50%, plan pays 50% (after deductible) | You pay 50%, plan pays 50% (after deductible) |
| Class IV Expenses: Orthodontia | Not covered | You pay 50%, plan pays 50% (maximum lifetime benefit of $1,500) |
| Class IX Expenses: Implants | Not covered | You pay 50%, plan pays 50% (after deductible) |
*Note: If you visit an out‐of‐network provider, you are responsible for any charges above the usual, customary, and reasonable (UCR) limits.
Use your dental benefits wisely
Here’s how to make the most of your dental benefits:
Choose a network provider.
Each time you need dental care, you have a choice of providers. Selecting a Delta Dental participating dentist will ensure you receive the highest benefits from your plan. To find a provider, go to the Delta Dental website.
Present your plan identification.
Give your provider's office the information they need to bill your insurance. The group number is 21412 and your member number is your Social Security number. The plan is through Delta Dental of California.
Submit for a pretreatment estimate.
You should submit a request for a pre-treatment estimate for procedures and services your dentist believes will exceed $300 (procedures such as crowns, inlays, bridges, and periodontics). For more information, call Delta Dental at (888) 643-3110 or visit the Delta Dental website.
Check your claim status.
You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more on the Delta Dental website.