Dental - Human Resources - Santa Clara University

Dental Plan Option

Using the Plan

Dental benefits are another important element of your overall health. With proper care, your teeth can and should last a lifetime.

Santa Clara University provides dental care coverage through Delta Dental. Under this plan, you may receive care from any dentist you wish. If you obtain dental care services from a dentist who participates in the Delta Preferred Option (DPO) network, you may have the opportunity to save money.

Dentists participating in the Delta Preferred Option network agree to discount their charges, and benefits are based on discounted fees. You may locate a participating dental provider on the Delta Dental website or by calling (800) 765-6003.

You also have the option of obtaining dental care services from dentists who do not participate in the DPO network. Since the fees for Non-DPO dentists are not discounted (as they are with network providers), your out-of-pocket expenses may be greater.

PLAN HIGHLIGHTS	DELTA DENTAL
PLAN HIGHLIGHTS	IN-NETWORK	OUT-OF-NETWORK ⁽¹⁾
General Information	When you obtain dental services from network providers, you will receive higher coverage.	You may receive dental care from any dentist you wish. If you receive care from non-network dentists, your coinsurance will be higher.
Annual Deductible	Waived for Preventive Care Services
Individual	$25	$25
Family	$75	$75
Annual Maximum Benefit	$3,500	$3,500
Preventive Services
X-rays; Cleanings; Examinations	Eligible Charges Covered at 100%	Eligible Charges Covered at 100%
Routine Basic Services
Amalgam Fillings; Extractions; Root Canals	Eligible Charges Covered at 100%	Eligible Charges Covered at 80%
Major Services
Bridges; Dentures; Crowns, Implants	Eligible Charges Covered at 60%	Eligible Charges Covered at 50%
Orthodontia Services (employee, spouse/domestic partner, and dependent children to age 26 only)
	Eligible Charges Covered at 50%, up to a Lifetime Maximum of $3,000	Eligible Charges Covered at 50%, up to a Lifetime Maximum of $3,000

^{(1) Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and the program allowance for no-Delta Dental dentists.}

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