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Below explanation is for California plan only

Delta Dental logo  DeltaCare USA Senior Dental HMO plan 
Toll free (877)566-5454
When you enroll in DeltaCare USA, you select a PMI network dentist to provide your dental care. With DeltaCare USA, you must visit your selected primary care dentist in order to receive benefits. When you need specialty care, your primary care dentist can obtain a referral. Advantages of the DeltaCare USA plan include low or no copayments for services, no deductibles and no maximums on services provided by primary care dentists.

Dues are easy to afford:

  • Only $135 per year for a single membership
  • PLUS a one-time $15 administration fee

 
(A) Deductibles None
(B) Lifetime Maximums None
(C) Professional Services An Enrollee may be required to pay a Copayment amount for each procedure as shown in the Description of Benefits and Copayments, subject to the Limitations and Exclusions.
Copayments range by category of service. Examples are as follows:
Diagnostic Services   No Cost - $5
Preventive Services No Cost - $150
Restorative Services No Cost - $425
Endodontic Services No Cost - $475
Periodontic Services $45 - $450
Prosthodontic Services, Removable $20 - $495
Prosthodontic Services, Fixed $20 - $425
Oral and Maxillofacial Surgery $35 - $150
Adjunctive General Services No Cost - $50

NOTE: Some services may not be covered. Certain services may be covered only if provided by specified providers, or may be subject to an additional charge.

Limitations apply to the frequency with which some services may be obtained. For example: cleanings are limited to once in each 6-month period; replacment of removable and fixed dentures and crowns is limited to once in any 5-year period.

(D) Outpatient Services Not Covered
(E) Hospitalization Services Not Covered
(F) Emergency Health Coverage The Enrollee may receive a maximum Benefit up to $100 per emergency, per Enrollee.
(G) Ambulance Services Not Covered
(H) Prescription Drug Services Not Covered
(I) Durable Medical Equipment Not Covered
(J) Mental Health Services Not Covered
(K) Chemical Dependency Services Not Covered
(L) Home Health Services Not Covered
(M) Other Not Covered

DeltaCare® USA

Advantages

DeltaCare USA is our prepaid plan that features set copayments, no annual deductibles and no maximums for covered benefits. Enrollees must select a primary care dentist in the DeltaCare USA network from whom they receive treatment as in a traditional dental HMO.1

Our DeltaCare USA plans promote great dental health for your enrollees and their families with quality dental benefits at an affordable cost. By covering many diagnostic and preventive services at no cost or with very low copayments, we encourage regular preventive dental visits. Enrollees select a DeltaCare USA dentist to provide most covered services1. All of our network dentistsí offices are independently-owned, and must adhere to Delta Dentalís standards of care, quality and service.

Benefits

  • Extensive benefits
  • No deductible or annual dollar maximums
  • No copayments or low copayments for most diagnostic and preventive services
  • Coverage for more than 250 procedures, including additional cleanings, bleaching, and tooth whitening
  • No exclusions for pre-existing conditions or missing teeth
  • Clearly defined out-of-pocket costs
  • Low turnover of network dentists; enrollees can establish a long-term relationship with their dentists
  • Ability to change selected or assigned network dentists via telephone or Internet
  • Easy referrals to a large specialty care network
  • No claim forms to complete
  • Expanded business hours for toll-free customer service
  • Outstanding quality assurance program that includes credentialing, a quality management program and regular office visits.

If you need an Adobe® Reader to view PDF documents you may
from the Adobe website. 

Download DeltaCare USA Senior DHMO .pdf Application

Download your DeltaCare USA Senior DHMO Brochure

DeltaCare USA DHMO Northern California Dentist Database
DeltaCare USA DHMO Southern California Dentist Database
YOU MUST CHOOSE A PRIMARY DENTIST TO PUT ON OUR APPLICATION.
Or you can fill in this form to have your Senior DeltaCare Dental HMO Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 877-Look4Life (877-566-5454).
Senior DeltaCare Dental HMO Insurance Coverage Requested
Our Ages
(over age 65)
  My Age or DOB       Spouse's Age  
People Covered

Customer Information
Full Full Name
E-mail
Street Address
City
County
State
Zip Code
Home Phone
Work Phone
FAX

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Phone:   (760) 433-0300    |   Fax:   (760) 433-0304
Toll-Free 1-877-Look4Life  (1-877-566-5454)

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