Dental Plan
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Delta Dental-Retiree Group
P.O. Box 997330
Sacramento, CA
95899-7330
Phone: (800) 765-6003
Website:
www.deltadentalca.org
Retiree Basic Group number: (4063-0101 + SSN)
Retiree Premium Group number: (4063-0014 + SSN)
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Delta Dental of California
All retirees are eligible to enroll in a dental plan. Retiree may
elect to enroll their spouse, registered domestic partner, and/or dependent
children at the time of retirement or during Open Enrollment. Spouses, domestic
partners, and/or dependent children may also be added within 30 days of a
“Qualified Status change Event.” Once you have enrolled in a dental plan, that
coverage will continue year to year until you make a change.
Retirees pay 100% of the cost for themselves, their
spouse/domestic partner, and/or their dependent children coverage. .
"REMEMBER 30 DAYS"
You must
contact the Employee Benefits Office within 30 days of the date of qualifying
status change event to make a change to your medical, or dental coverage.
Failure to do so within the 30 day time frame will result in your inability to
make the change until the next Open Enrollment.
Basic Dental Plan
The Basic Dental plan pays benefits based upon a fee schedule. For
specific coverage information for the Basic Dental plan,
click here.
Important (eff 1/1/10 ): 12/24 Month Lock
– If you select the dental plan, you must remain in the plan for a minimum of 12
consecutive months before you can waive coverage. If you add a dependent
midyear, both you and the dependent must remain in the plan for a minimum of 12
consecutive months before you can waive coverage or drop dependents. Only a
“Qualified Status Change Event” causing a loss of dependent status will allow
for a reduction in dependent coverage without fulfilling the 12 consecutive
months requirement.
If you drop coverage for yourself or a dependent, coverage under
the dental plan will not be available until 24 consecutive months have passed.
Hardcopies of the Evidence of Coverage booklet that contains
details about the plan is also available from the Employee Benefits Office.
The Retiree Dental Plan do not coordinate with itself or each
other. Therefore you may only be enrolled in one County-sponsored retiree
dental plan. You may not be enrolled in the Dental plan as a retiree and as a
beneficiary or as a spouse of another retiree. Children may only be enrolled as
dependents of one retiree.
A list of Delta Preferred Option Dentists and Delta Dentists can be
obtained by calling 1-800-765-6003 or logging onto to Delta Dental’s website at
www.deltadentalca.org. This list will identify those dentists who can
provide care for individuals who have mobility impairments or have special
health care needs.
Inquire about the availability of documents in
alternate formats.
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