DENTAL INSURANCE

City employees may choose from three dental options administered by Delta Dental.

  1. Delta Dental Preventive Only provides preventive dental care only. It does not cover other services such as fillings, crowns and orthodontia. Those who choose this option receive additional pre-tax LAwell dollars of $5.00 per month or $2.50 per month for regular half-time employees.

  2. DeltaCare USA DHMO is a dental HMO; you must choose a Primary Care Dentist (PCD) and see this dentist first whenever you need care.

  3. Delta Dental PPO provides care through a network of dentists who have agreed to offer covered services at discounted rates.

 

Dental Plan Highlights

The table below displays only a few highlights of your dental benefit options. For more information about your coverage, or to get a copy of the complete terms of coverage, log in to your Delta Dental account and view “Benefit Details.” 

Delta Dental
Preventive Only
DeltaCare USA DHMO
 Delta Dental PPO
Features a network of providers Yes Yes Yes
Offers flexibility to use non-network providers Yes No Yes - paid at
out-of-network level
Covers preventive care Yes Yes Yes
Covers services other than preventive care
such as basic and major services		 No Yes Yes
Has a calendar year deductible No No Yes
Has an annual maximum benefit No No Yes
Includes set copays for most services No Yes No
Requires you to choose a primary care dentist No Yes No
Covers emergency care outside the
provider network*		 No Yes - up to $100 per
incident after any copay**		 Yes - paid at
out-of-network level

* For emergency care provided by a dentist who is not part of Delta’s network, you must pay for services and submit a claim. For claim instructions, contact Delta Dental Customer Service at 800-765-6003 for PPO or 800-422-4234 for DeltaCare USA DHMO. 

** Contact your primary care dentist (PCD) or Delta Dental Customer Service at 800-422-4234 before receiving treatment. If you do not, you may be responsible for any charges related to treatment. 

Dental Plan Coverage Comparison

This table shows a brief summary of how the three dental options pay for certain services. If you have questions about how a specific service is covered, call 800-765-6003 for Delta Dental Preventive Only and PPO or 800-422-4234 for DeltaCare USA DHMO.

How Benefits Are Paid Delta Dental
Preventive Only		 DeltaCare USA DHMO Delta Dental PPO
In-Network Out-of-Network****
Calendar Year Deductible None None $25/person; $75/family $50/person; $150/family
Diagnostic and Preventative Care
Two cleanings and
exams/year

Two sets of bitewing X-rays/year for children up to age 18; one set/year for adults

Two fluoride treatments/year for children up to age 19 (not covered by Preventive Only)		 Plan pays 100% in-network or 100% of R&C* out-of-network (includes an additional oral exam and routine cleaning during pregnancy) Plan pays 100% — covers one series of four bitewing X-rays in any six-month period for children or adults Cleanings, X-rays and exams: Plan pays 100% with no deductible (includes an additional oral exam and a routine cleaning during pregnancy). Diagnostic and Preventive Care charges are not applied to the annual maximum. Cleanings, X-rays and exams: Plan pays 80% of R&C* with no deductible (includes an additional oral exam and a routine cleaning during pregnancy). Diagnostic and Preventive Care charges are not applied to the annual maximum.
Basic Services
Amalgam fillings, extractions Not covered Plan pays 100% for fillings; you pay up to $90 for extractions Plan pays 80% Plan pays 80% of R&C*
Root Canal Not covered Your copay is $45 – $220 per procedure Plan pays 80% Plan pays 80% of R&C*
Periodontal scaling and root planing Not covered Plan pays 100% up to 4 quadrants in 12 months Plan pays 80% once per quadrant every 24 months Plan pays 80% of R&C,* once per quadrant every 24 months
Major Services
Crowns Not covered Your copay is $55 – $195 per procedure** Plan pays 80% Plan pays 50% of R&C*
Dentures Not covered Your copay is $80 – $170 per procedure Plan pays 50% Plan pays 50% of R&C*
Implants Not covered Not covered Plan pays 50% Plan pays 50% of R&C*
Orthodontia
Children under age 19 Not covered Your copay is $1,000 plus start-up fees of $300 Plan pays 50% Plan pays 50% of R&C*
Children age 19 to age 26 Not covered Your copay is $1,350 plus start-up fees of $300 Plan pays 50% Plan pays 50% of R&C*
Adults Not covered Your copay is $1,350 plus start-up fees of $300 Not covered Not covered
Plan Maximums
Annual maximum benefit (does not include diagnostic and preventive services) Not applicable None $1,500/person***
Lifetime orthodontia maximum benefit Not covered None $1,500/child
 

* R&C is the reasonable and customary charge – the usual charge for specific services in the geographic area where you are treated.

** When there are more than six crowns in the same treatment plan, an enrollee may be charged an additional $100 per crown beyond the sixth unit. 

*** If you use both in-network and out-of-network dentists, your total annual maximum benefit will never be more than $1,500 per person.

 **** Employees accessing out-of-network services may be required to pay for services in full and submit claims directly to Delta Dental for reimbursement. The employee is also required to ensure their payments for services are accurate.

 

Your Premium Costs 2024

Click below to see the dental coverage costs per pay period for Full-Time and Half-Time Employees (All MOUs)

Full-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $6.21 ($2.50)^ $3.71
Employee & Spouse/DP^^ $3.71 $3.09 $6.80
Employee + Child(ren)^^ $3.71 $3.91 $7.62
Employee + Family^^ $3.71 $7.30 $11.01
DeltaCare USA DHMO
Employee Only $7.97 $0.00 $7.97
Employee & Spouse/DP^^ $7.97 $6.89 $14.86
Employee + Child(ren)^^ $7.97 $5.36 $13.33
Employee + Family^^ $7.97 $9.25 $17.22
Delta Dental PPO
Employee Only $21.46 $3.79 $25.25
Employee & Spouse/DP^^ $21.46 $25.89 $47.35
Employee + Child(ren)^^ $21.46 $27.63 $49.09
Employee + Family^^ $21.46 $44.39 $65.85

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.


Half-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $4.96 ($1.25)^ $3.71
Employee & Spouse/DP^^ $3.71 $3.09 $6.80
Employee + Child(ren)^^ $3.71 $3.91 $7.62
Employee + Family^^ $3.71 $7.30 $11.01
DeltaCare USA DHMO
Employee Only $7.97 $0.00 $7.97
Employee & Spouse/DP^^ $7.97 $6.89 $14.86
Employee + Child(ren)^^ $7.97 $5.36 $13.33
Employee + Family^^ $7.97 $9.25 $17.22
Delta Dental PPO
Employee Only $12.63 $12.62 $25.25
Employee & Spouse/DP^^ $12.63 $34.72 $47.35
Employee + Child(ren)^^ $12.63 $36.46 $49.09
Employee + Family^^ $12.63 $53.22 $65.85

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Your Premium Costs 2023

Click below to see the dental coverage costs per pay period for Full-Time and Half-Time Employees (All MOUs)

Full-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $6.29 ($2.50)^ $3.79
Employee & Spouse/DP^^ $3.79 $3.15 $6.94
Employee + Child(ren)^^ $3.79 $4.00 $7.78
Employee + Family^^ $3.79 $7.45 $11.24
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP^^ $8.39 $7.25 $15.64
Employee + Child(ren)^^ $8.39 $5.64 $14.03
Employee + Family^^ $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $21.91 $3.86 $25.77
Employee & Spouse/DP^^ $21.91 $26.40 $48.31
Employee + Child(ren)^^ $21.91 $28.18 $50.09
Employee + Family^^ $21.91 $45.29 $67.20

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.


Half-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $3.79 ($1.25)^ $3.79
Employee & Spouse/DP^^ $3.79 $3.15 $6.94
Employee + Child(ren)^^ $3.79 $4.00 $7.78
Employee + Family^^ $3.79 $7.45 $11.24
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP^^ $8.39 $7.25 $15.64
Employee + Child(ren)^^ $8.39 $5.64 $14.03
Employee + Family^^ $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $12.89 $12.88 $25.77
Employee & Spouse/DP^^ $12.89 $35.42 $48.31
Employee + Child(ren)^^ $12.89 $37.20 $50.09
Employee + Family^^ $12.89 $54.31 $67.20

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Your Premium Costs 2022

Click below to see the dental coverage costs per pay period for Full-Time and Half-Time Employees (All MOUs)

Full-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $6.35 ($2.50)* $3.85
Employee & Spouse/DP $3.85 $3.21 $7.06
Employee + Child(ren) $3.85 $4.07 $7.92
Employee + Family $3.85 $7.59 $11.44
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP $8.39 $7.25 $15.64
Employee + Child(ren) $8.39 $5.64 $14.03
Employee + Family $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $22.30 $3.93 $26.23
Employee & Spouse/DP $22.30 $26.87 $50.98
Employee + Child(ren) $22.30 $28.68 $50.98
Employee + Family** $22.30 $46.09 $68.39

* Additional LAwell dollars credited to employee.
** Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Half-Time Employees

Coverage Level City Pays... Half-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $5.10 ($1.25)* $3.85
Employee & Spouse/DP $3.85 $3.21 $7.06
Employee + Child(ren) $3.85 $4.07 $7.92
Employee + Family $3.85 $7.59 $11.44
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP $8.39 $7.25 $15.64
Employee + Child(ren) $8.39 $5.64 $14.03
Employee + Family $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $13.12 $36.05 $49.17
Employee & Spouse/DP $13.12 $37.86 $50.98
Employee + Child(ren) $13.12 $37.86 $50.98
Employee + Family** $13.12 $55.27 $68.39

* Additional LAwell dollars credited to employee.
** Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

The amount of premium you are responsible for depends on:

  • Your employment status (full-time or half-time)

  • The specific dental plan you choose

  • The coverage level you choose (LAwell offers the same four coverage level options for dental plans as for medical enrollment). The coverage levels are:

    • Employee Only (Single Party – Employee)

    • Employee & Spouse/Domestic Partner (DP)* (Two Party – Employee and another adult legal spouse or legal DP)

    • Employee + Child(ren)* (Two+ Party – The Employee and any legal child and/or disabled child dependents in the household)

    • Employee + Family* (Three+ Party – The Employee and all legal dependents)

      *Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment of the employee. Visit Domestic Partnership for further details

 

City’s Subsidy

The majority of dental insurance premium costs (for employee-only coverage) are paid by the City’s subsidy. However, the City’s subsidy is subject to eligibility.

The City’s maximum DHMO dental plan subsidy is $15.94 per month for all employees. The City’s maximum PPO dental plan subsidy is $42.93 per month for full-time employees and $25.25 per month for half-time employees.

1. Your employment status (full-time or half-time)

2. The specific dental plan you choose.

3. The coverage level you choose (the number of dependents* you cover, if any)

* Eligibility of dependents is subject to LAwell program rules.

Subsidy Eligibility

The employee portion of the premiums, if any, is automatically deducted from your paychecks two times per month. Your eligibility to receive the City’s subsidy for your benefits is evaluated on a biweekly basis. Each and every pay period, full-time employees must have a minimum of 40 compensated hours (such as HW, SK, VC, HO, etc.), and half-time employees must have a minimum of 20 compensated hours. If you do not have sufficient compensated hours in any given pay period, you will be required to pay the full unsubsidized premium for your benefits to continue, and a bill for these outstanding benefits costs will be sent to you by the Personnel Department, Direct Billing Section. Other situations, including benefit termination, may apply.

Delta Dental Website

Register for a Delta Dental online account to verify your assigned dentist and find other information, such as eligibility, your enrolled family members, claim status, and benefit specifics.

Here’s how to register online:

  1. Go to Delta Dental

  2. Select “Log in” at the top right side of the page.

  3. Select “Create an account.” 

  4. Select “Enrollee/Adult Dependent” from the drop-down menu. Then select “Next.”

  5. Enter your personal information. 

Find a Network Provider

 In California, 89.9% of dentists belong to a Delta network. Learn how to find a provider for each dental plan below.

Delta Delta Dental Preventive Only plan

If you enroll in Delta Dental Preventative Only, you can choose a network or non-network provider each time you need care.

To find a Delta Dental network provider, you can request a provider directory (at no cost):

  • Go to Delta Dental, under “Find a Dentist”, enter your zip code and from the drop-down menu, choose your plan or

DeltaCare USA DHMO plan

If you enroll in DeltaCare USA DHMO, you must select a Primary Care Dentist (PCD) from the DeltaCare USA network to receive benefits. You may change your PCD at any time during the year. The DeltaCare USA DHMO option does not cover care that is not coordinated by your PCD, therefore it is important that you do not go to another dentist without first contacting Delta Dental Customer Service.

To find a Delta Dental network provider, you can request a provider directory (at no cost):

  • Go to Delta Dental and under “Find a Dentist” enter your zip code and from the drop-down menu, choose your plan or

  • Call the DeltaCare USA DHMO Customer Service at 800-422-4234.

Delta Dental PPO plan

If you enroll in Delta Dental PPO, you can choose a network or non-network provider each time you need care. Dentists who are not part of Delta’s PPO network may still be Delta dentists and agree to charge for services in accordance with Delta’s reasonable and customary (R&C) reimbursement levels.

To find a Delta Dental network provider, you can request a provider directory (at no cost):

  • Go to Delta Dental and under “Find a Dentist” enter your zip code and from the drop-down menu, choose your plan or