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.