Dental

Effective January 1, 2008, indemnity dental benefits for retirees living in any state other than Hawaii are provided by Delta Dental of California.  The Delta Dental PPO program allows you the freedom to visit any licensed dentist, including a dentist from the Delta Dental Premier network. However, there are advantages to visiting a Delta Dental PPO dentist instead of a Premier or non-Delta Dental dentist.


Delta Dental PPO Dentist

  • You will usually pay the lowest amount for services when you visit a PPO dentist, as the PPO dentist has agreed to accept a reduced fee for PPO patients.
  • You are only charged your share at the time of treatment, and Delta Dental pays its portion directly to the dentist.
  • PPO dentists will complete claim forms and submit them for you.


Delta Dental Premier Dentist

  • Premier dentists will not balance bill above Delta Dental’s approved amount; however, your out of pocket costs may be higher with Premier dentists than with PPO dentists.
  • You are only charged your share at the time of treatment, and Delta Dental pays its portion directly to the dentist.
  • Premier dentists will complete claim forms and submit them for you.


Non-Delta Dental Dentists

  • You are responsible for the difference between the amount Delta Dental pays and the amount your non-Delta Dental dentist bills. You will usually have the highest out of pocket costs when you visit a non-participating dentist.
  • Non-Delta Dental dentists may require you to pay the entire amount of the bill in advance and wait for reimbursement.
  • You may have to complete and submit your own claim forms, or pay the non-participating dentist a fee to submit them for you. 
  • If you visit a non-Delta Dental dentist, benefit payments will be mailed directly to you.

You may visit the Delta Dental website or call customer service to find a participating PPO dentist or Premier dentist.

  • Customer Service 800-765-6003
  • Address Delta Dental of California
  • Street San Francisco, CA 94105
    Online Services
    www.deltadentalins.com
  • Claims Address P. O. Box 997330
    Sacramento, CA 95899-7330

Delta Dental Plan Summary

Dental Benefits

Maximum Benefit                                      $2,750 per person per calendar year

Diagnostic and Preventive Benefits

In PPO Network

  Out of PPO Network

Oral examinations, routine cleanings,
Bitewing x-rays, fluoride treatment,
Sealants, specialist consultations,
Emergency palliative treatment
          100%            100%
Basic Benefits    
Fillings, root canals, other x-rays, space
Maintainers, periodontics (gum treatment),
Tissue removal (biopsy), oral surgery 
(extractions)
           50%             50%
Crowns, Other Cast Restorations    
Crowns, inlays, onlays and cast restorations            50%             50%
Prosthodontics    
Bridges, partial dentures, full dentures,
Implants
           50%             50%

Note: Fees are based on PPO fees for in network dentists and the maximum plan allowance (MPA) for out of network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist’s actual fee. You can be balance billed for services received for out of network dentists.

Refer to the Summary Plan Description for a complete list of benefits, limitations, and exclusions.

MetLife Dental Plan

Retirees residing in California, Colorado, Arizona, Nevada, Montana, Oklahoma, Illinois, Maryland, Ohio, and Texas have the option of receiving dental benefits through a Managed Care plan provided by MetLife Dental Plan.

SafeGuard Dentists

  • All services must be received from dentists contracted with MetLife. You must designate a Selected General Dentist when you enroll in the plan who will provide or manage your dental care.
  • You may change your Selected General dentist up to once a month by either going online to the Safeguard website or calling MetLife customer service. Retirees and dependents do not have to designate the same MetLife General Dentist.
  • Plan benefits are based on a Schedule of Benefits which lists the services available as well as the copayment you must pay for each procedure. The schedule of benefits is provided at the time of enrollment.
  • There are no maximum annual benefits or deductibles that apply to your plan. All benefit payments are determined by the Schedule of Benefits.
  • Your plan covers diagnostic and preventive treatment including x-rays, basic services (such as fillings, root canals, periodontics, oral surgery and extraction), crowns, prosthodontics (including bridges and dentures) as well as orthodontia.
  • During the course of treatment, your MetLife selected general dentist may recommend the services of a dental specialist, and may refer you directly to a contracted MetLife specialty care provider for endodontics, oral surgery or periodontics; no referral or pre-authorization from MetLife is required for these contracted specialists. Your selected general dentist will obtain pre-authorization from MetLife for any referrals to participating orthodontists or pediatric specialists.

Non-SafeGuard Dentists

  • No benefits are provided for services provided by non-Safeguard dentists.

You may visit the website or call customer service to find a participating SafeGuard dentist.

Group No. 584, Plan SG 100A  
Member Services 800-ASK4-MET

press 3,1,0*** to get a representative immediatel (800-275-4638)

Online Services www.safeguard.net
Mailing Address SafeGuard
c/o Member Services
P. O. Box 981282
El Paso, TX 79998-1282

Download the Schedule of Benefits (PDF File).

Hawaii Dental Service (HDS)

Retirees residing in Hawaii receive dental benefits from Hawaii Dental Service (HDS).

As of March 1, 2008, members can choose between the original Low Option Plan or the new High Option Plan. The High Option Plan will closely match the benefits previously provided by the Direct Pay Dental Plan. Specific information was mailed to all retirees in January.

If you changed to the high option plan, any benefits paid for services received in 2008 under the low option plan will be applied to the maximum under the new plan.

HDS Dentist

  • You will usually pay the lowest amount for services when you visit a HDS participating dentist, as HDS dentists have agreed to accept a reduced fee.
  • You are only charged your share at the time of treatment, and Hawaii Dental Service pays its portion directly to the dentist.
  • HDS dentists will complete claim forms and submit them for you.
  • HDS is a member of the Delta Dental Plan Association, and about 96% of dentists in Hawaii are HDS participating dentists.
  • Hawaii Dental Service has participating dentists available on the islands of Hawaii, Kauai, Lanai, Maui, Molokai, Oahu.

Non-HDS Dentists

  • You are responsible for the difference between the amount HDS pays and the amount your non-HDS dentist bills. You will usually have the highest out of pocket costs when you visit a non-participating dentist.
  • Non-HDS dentists may require you to pay the entire amount of the bill in advance and wait for reimbursement.
  • You may have to complete and submit your own claim forms, or pay the non-participating dentist a fee to submit them for you.

You may visit the website or call customer service to find a participating HDS dentist.

Customer Service

On Oahu 529-9248
or toll free at 1 800-232-2533, ext. 248

DenTel (automated phone service)     

On Oahu 545-7711
Or toll free at 1-800-272-7204
Online Services

www.deltadentalhi.org