Dental benefits are provided through Delta Dental of California, the nation's largest, most experienced dental benefits system with more than 11,300 PPO dentist locations in California. Delta provides you with a wide choice of participating general dentists and specialists.

Your identification number is listed on your Delta Dental Insurance Card or you may use the primary subscriber's SSN.

• www.deltadentalins.com
• Customer Service (866) 499-3001

Eligibility:

Primary enrollee, spouse and eligible dependent children to the end of the month the dependent turns 26.

Deductibles: Deductible waived when seeing an in-network provider.  Non-Delta Dental PPO dentists - $50 per person/$150 per family each calendar year.

Maximums: $1,500 per person each calendar year. Diagnostic and Preventive services count towards this maximum.

Waiting Periods: There are no waiting periods.

• Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist's submitted fees.
• Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.

deltadentalins.com

This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.