Dental Frequently Asked Questions

General

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

No, you must have a permitting event to make changes to your dental enrollment outside of open enrollment.   Your personnel office can determine if your change is an allowable event.

2.   Can I cancel my dental benefits?

Yes, you may cancel at any time; however, you cannot re-enroll back into a dental plan until the next open enrollment, or if 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 never allowed under any circumstance.   If this is happening, both of you must immediately notify your 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 him or her from my dental benefits?

Yes, it is a mandatory deletion, unless they are a disabled dependent.  He or she may continue to be enrolled after attaining age 26 if he/she is incapable of self-support because of physical disability or mental incapacity and if he/she is 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 after the age of 26.

5.  How do I delete my child that is/has turned 26 years old?

It is your responsibility to inform your personnel office of changes with your dependents. Your personnel office can assist you in removing ineligible dependents from your dental plan. The deletion of your 26-year-old dependent is not automatic. You must inform your personnel office and submit a complete 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 form (Std. 692) to your personnel office if you retire within 120 days of your 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 change dental plans outside the annual open enrollment period only if your dental plan is no longer available to you.   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 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, available from your personnel office or your dental carrier.   If you are unable to resolve your complaint through your carrier, you may contact CalHR at (916) 322-0300 for assistance.

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 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 (e.g., the active employee’s unborn child).

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 provider 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 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 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.  The dentists available through each prepaid plan have contracted with that plan to provide services to its enrollees.  Your choice is restricted to dentists who have contracted with your plan (called “participating dentists”).  Contact the dental plan directly to obtain a list of its 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 dental providers, 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 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 personnel office.

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 Costs 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, or 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.

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 of the plans listed below:

Prepaid Dental Plans

DeltaCare USA
12898 Towne Center Drive
Cerritos, CA 90703
(800) 422-4234
www.deltadentalins.com/state/

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

SafeGuard
5 Park Plaza, Suite 1850
Irvine, CA 92614
(800) 880-1800
www.metlife.com/group-dental/safeguard/soc

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 in that you are required to choose your dentist from a list of dental providers.  However, the prepaid plans provide benefits at less 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 will send you an identification card indicating your enrollment in the Delta Dental PPO plus Premier plan and 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.

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

Although claim forms are required, the forms will be completed for you at no charge if you receive services from a participating Delta dentist. If you receive services from a non-Delta dentist, you may be required to complete the forms yourself or pay a fee to have the dentist's office do it 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 mails you an evidence of coverage booklet with your ID card.  Your personnel office also may have a small supply of these booklets.  If you do not receive your booklet, contact Delta at (800) 225-3368 to request an evidence of coverage booklet for group number 9949.  Evidence of coverage booklets are also available on Delta’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 PPO plus Premier Plan.

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

For represented employees in the Delta Dental PPO plus Premier Basic plan, there is an annual maximum benefit of $2,000 for employees and $1,000 for each dependent.  For some services, the level of benefits for the enrolled dependent is less than the level of benefits for the employee.  There is a $50 deductible for each family member (maximum of $150 per family per year).  The required $50 deductible for each participant is waived for preventive and diagnostic care.

For excluded employees in the Delta Dental PPO plus Premier Enhanced plan, there is an annual maximum benefit of $2,000 for both the employee and each eligible dependent.  The level of benefits for each participating family member is the same as the level of benefits for the employee.  There is a $25 deductible for each family member (maximum of $100 per family per year).  The required $25 deductible for each participant is waived for preventive and diagnostic care.

The annual deductibles do not apply to diagnostic and preventive benefits such as x-rays, examinations, and cleanings.   If the dental costs exceed the annual maximum, the employee is responsible for paying the difference.

For a detailed explanation of the limitations and exclusions of the Delta Dental PPO plus Premier plans, consult the evidence of coverage booklet, available by calling Delta at (800) 225-3368.

Preferred Provider Plan

1.  What is my PPO group number?

Your PPO group number is 9946.

2.  Will I receive an ID card?

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.

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 dentist, you may be required to complete the forms yourself or pay a fee to have the dentist's office do it for you.  The dental office should be able to provide you with the claim form, or you may contact Delta 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 will mail you an evidence of coverage booklet with your ID card.   Your personnel office also may have a small supply of these booklets.  If you do not receive your booklet, contact Delta at (800) 225-3368 to request an evidence of coverage booklet for group number 9946.  Evidence of coverage booklets are also available on Delta’s website at www.deltadentalins.com/state.

5.  What is the level of benefits under the PPO plan?

In-Network:  The PPO plan provides an annual in-network maximum benefit of $2,000 for the employee and all enrolled dependents that use a participating PPO dentist.  There is also a $25 annual deductible for each enrollee (maximum of $100 per family) using a participating PPO dentist.

Out-of-Network:   The PPO plan provides an annual out-of-network maximum benefit of $1,000 for the employee and all enrollment dependents that use a participating non-PPO dentist.   There is also is a $75 annual deductible for each enrollee (maximum of $200 per family) using a non-PPO dentist.

These deductibles do not apply to diagnostic and preventive benefits such as x-rays, examinations, and cleanings.

For a detailed explanation of the limitations and exclusions of the Delta Dental PPO plan, consult the evidence of coverage booklet, available by calling Delta at (800) 225-3368.