Dental Frequently Asked Questions

General Questions

1.   Can I change my dental plan at any time?

No, dental plans can only be adjusted during the annual Open Enrollment or when you experience a permitting event. Your departmental personnel office can help you determine if you have a permitting event that qualifies for a dental plan change.

2.   Can I cancel my dental benefits?

Yes, you may cancel your dental benefits at any time; however, you cannot re-enroll back into a dental plan until the next Open Enrollment unless you have a permitting event.

3.  My spouse and I are both state employees. Can we cover each other on our state-sponsored dental plans?

No. Dual coverage is not allowed under any circumstance.  If this is happening, both of you must immediately notify your department's personnel office(s) or CalPERS if you or your spouse is retired.

4.  My dependent child is going to turn 26 years old. Do I have to delete them from my dental benefits?

Yes, this is a mandatory deletion. The only exception is if your dependent is incapable of self-support because of a disability and dependent upon the eligible employee or annuitant for support and care. A disability certification (CalPERS HBD 34) is required to ensure disabled dependent children remain covered. Your department's personnel office must be informed prior to your dependent turning 26. 

5.  How do I delete my child once they turn 26 years old?

 The deletion of your 26-year-old dependent is not automatic. You must inform your department's personnel office and submit a completed ​ Dental Plan Enrollment Authorization Form (STD.692) within 60 days of the event taking place.

6.  I’m retiring soon. Do my dental benefits carry over automatically into retirement?

No, you must submit a Dental Enrollment Authorization Form (Std. 692) to your departmental personnel office if you retire within 120 days of your retirement separation.

7.  Once I’ve selected a dental plan, may I change dental plans if my dentist cancels their contract with the dental carrier?

No. You may only change dental plans outside the annual Open Enrollment period if you experience a permitting event. For example, if you move to an area where your dental plan is more than 50 miles from your residence, you may enroll in another plan. If you have any questions, contact your department's personnel office.

8.  What should I do if I have a problem or complaint regarding my dental plan or dentist?

Many problems can be resolved by contacting your dental plan's customer service department. You should also refer to the complaint procedure outlined in your dental plan evidence of coverage booklet, which is available from your department's personnel office or your dental carrier.   

9.  What should I do if the payroll deduction for my dental plan is incorrect or is not shown on my warrant stub?​​

When you enroll in a state-sponsored dental plan or change the coverage, it is important to carefully check your pay warrant to verify that the premium is being paid to the correct dental plan. If the deduction is incorrect, or has not started by the effective date, report the discrepancy to your department's personnel office.

10.  Can a surviving spouse add other dependents during open enrollment?

Yes, but only if the dependents had a relationship to the deceased employee prior to the employee’s death. For example, the surviving spouse may add a child who is born after the employee's death.

Prepaid Plans

1.   If I enroll in a prepaid dental plan, will I receive an identification card?​

Yes.  Shortly after your eligibility is established by your dental plan and you have selected a dentist, you will receive an identification card. The card is a reminder of which dental office you selected. Please confirm the address and telephone number of your selected dental office with your dental plan carrier.

2.  What if there are no participating dentists in my service area for any of the prepaid plans?

If you are unable to locate a participating provider within 50 miles of your residence, contact the plan's customer service for assistance. If it is determined that there are no prepaid providers in your service area, contact your department's personnel office for further assistance.

3.  What happens if I am enrolled in a prepaid plan and move out of California?

The state-sponsored prepaid plans are only offered in California. Before you move out of the state, contact your department's personnel office to change your dental plan. Be sure to inform them of your moving date.

4.  May I choose any dentist I want if I enroll in a prepaid plan?

No. Your choice is restricted to dentists who have contracted with your plan. Contact the dental plan directly to obtain a list of the participating dentists or to verify whether a particular dental provider is on the plan's list.

5.  Once I have selected a prepaid dentist and/or dental office, do I have to remain there?

No. If for any reason you feel you need to change to a new dentist, simply contact your dental plan. The customer service representative will assist you in locating another dentist from the plan's list of participating dental providers.

6.  What happens if my dentist decides to no longer participate in my prepaid plan?

Your dental plan will notify you if your dentist stops participating in the prepaid plan. You will be provided with the name of a new dentist or given the opportunity to select another participating dentist within 50 miles of your residence. If you are unable to locate another participating dentist in your service area, contact your dental plan.

7.  Do I have to pay monthly premiums for my dependents or myself if I enroll in a prepaid plan?

No. The State of California pays 100 percent of the monthly premium for you and your dependents enrolled in a prepaid plan.

8.  Do I have to pay an annual deductible if I am enrolled in a prepaid plan?

No.  There is no annual deductible.

9.  What cost share can I expect to pay if I enroll in a prepaid plan?

Depending on the type of dental service performed, you could be charged a co-payment.  Co-payments are payable at the time the service is rendered. For a listing of covered dental services and applicable co-payments, please see Coverage and Co sts for Certain Procedures: Prepaid Plans .

10.  What actions should I take in an emergency if I am enrolled in a prepaid plan?

Contact your dentist or dental office. If the emergency occurs after normal business hours, you are advised that there is no plan provider available, or you are more than 50 miles from your selected plan provider, you may receive treatment for the relief of pain from any non-plan provider. You must call your dental plan before obtaining out-of-area emergency care. Your plan will reimburse up to $400 per enrolled member per calendar year for emergency services.

11.   How do I access specialist services?​

The prepaid plans offer services in most dental specialties, including periodontics (treatment of diseased gums and bones), endodontics (root canal therapy), and oral surgery procedures. If your dental provider refers you to a specialist, the referral must be approved by the prepaid dental plan.

12.  Do my dependents have the same level of benefits that I do in my prepaid plan?

Yes, your dependents have the same level of benefits as you do. 

13.  If I am not currently enrolled in a prepaid plan, what things should I consider before I decide to change dental plans?

Is it important to you to maintain your current dentist?

If your answer is no, enrolling in a prepaid plan and selecting one of its participating dental providers may be a good choice for you.

Is the location of your dentist an issue for transportation purposes?

If your answer is yes, you may want to review the list of participating dental providers for each prepaid plan. You may find a provider within easy access by car or public transportation.

Are your out-of-pocket dental costs a significant financial consideration?

If your answer is yes, you should be aware that the prepaid plans have no monthly premium cost share or annual deductible and most services are provided at little or no cost to you.

Do you live outside of California?

If your answer is yes, you need to be aware that the prepaid plans are only available in California.

14.  How can I find out more about the state-sponsored prepaid dental plans?

Before changing plans, it is recommended that you request a copy of the plan brochure and list of participating dental providers for any plans you are considering. Review this information and select a dentist from the provider list prior to changing plans. For more information or to obtain a list of each plan’s member dentists, please call or visit the websites listed below:

Prepaid Dental Plans

DeltaCare USA
P.O. Box 1803
Alphareatta, GA 30023
(800) 422-4234
www.deltadentalins.com/state/

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

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.

Western Dental
530 South Main Street, 6th Floor
Orange, CA 92868
(866) 859-7525
www.westerndental.com/state-of-ca

If you decide to change dental plans, be aware that the prepaid plans provide less flexibility, and you are required to choose your dentist from a list of participating dentists. However, the prepaid plans provide benefits at a lower cost to you.​

Indemnity Plans

1.  What is my Delta Dental PPO plus Premier group number?

Your Delta Dental PPO plus Premier group number is 9949.

2.  Will I receive an ID card?

Delta Dental will send you an identification card indicating your dental group number. When you or a covered dependent goes to the dentist, you will need to provide this group number (9949) and the Social Security number of the state employee. The dental office will verify your eligibility and covered benefits directly with Delta Dental.

3.  Do I have to complete a claim form when I go to a Delta Dental dentist?

Although claim forms are required, the forms will be completed for you at no charge if you receive services from a participating Delta Dental dentist. If you receive services from a non-Delta Dental dentist, you may be required to complete the forms yourself or pay a fee to have the dentist's office complete them for you.

4.   How do I obtain an evidence of coverage booklet for the Delta Dental PPO plus Premier plan?

When you enroll in the Delta Dental PPO plus Premier plan, Delta Dental mails you an evidence of coverage booklet with your ID card.  Your department's personnel office also may have a small supply of these booklets. If you do not receive your booklet, contact Delta Dental at (800) 225-3368 to request an evidence of coverage booklet for group number 9949.  Evidence of coverage booklets are also available on Delta Dental's website at www.deltadentalins.com/state.

5.  As an active employee, I was enrolled in the Delta PPO plus Premier Enhanced plan.  Does the enhanced plan continue if I retire?

No. When the dental enrollment is processed by CalPERS, the plan is changed to the Delta Dental PPO plus Premier Basic Plan.

6.  What is the level of benefits under the Delta Dental PPO plus Premier plans?

For a summary of the benefits available under the Delta Dental PPO plus Premier plan, please review the dental handbook.

For a detailed explanation of the limitations and exclusions of the Delta Dental PPO plus Premier plan, consult the evidence of coverage booklet.

Preferred Provider Plan

1.  What is my PPO group number?

Your PPO group number is 9946.

2.  Will I receive an ID card?

No. When you or a covered dependent goes to the dentist, you will need to provide this group number (9946) and the Social Security number of the state employee. The dental office will verify your eligibility and covered benefits directly with Delta Dental.

3.  Do I have to complete a claim form when I go to a PPO dentist?

Although claim forms are required, the forms will be completed for you at no charge if you receive services from a participating PPO dentist.

If you receive services from a non-Delta Dental dentist, you may be required to complete the forms yourself or pay a fee to have the dentist's office complete the forms for you. The dental office should be able to provide you with the claim form or you may contact Delta Dental to have a claim form sent to you.

4.  How do I obtain an evidence of coverage booklet for the PPO plan?

When you enroll in the PPO plan, Delta Dental will mail you an evidence of coverage booklet with your ID card. Your departmental personnel office also may have a small supply of these booklets. If you do not receive your booklet, contact Delta Dental at (800) 225-3368 to request an evidence of coverage booklet for group number 9946. Evidence of coverage booklets are also available on Delta Dental's website at www.deltadentalins.com/state.

5.  What coverage is provided under the PPO plan?

For a summary of the benefits available under the Delta Dental PPO plan, please review the dental handbook.

​For a detailed explanation of the limitations and exclusions of the Delta Dental PPO plan, consult the evidence of coverage booklet.​