Dental Benefits & Claims

DENTAL BENEFITS PARTNER: DENTAL DENTAL

GENERAL INFORMATION

For full details about the dental benefits available from the DGA–Producer Health Plan, refer to the March 2025 Health Plan Summary Plan Description, beginning on page 91.

For a list of network dentists in your area, go to deltadentalins.com or call (800) 427-3237.

For Delta Dental coverage cards, call (800) 765-6003.

SCHEDULE OF DENTAL BENEFITS

Below is a summarized schedule of dental benefits under the Health Plan. 

Network Dentists Non-Network Dentists
Calendar Year Maximum $2,500 per person; Does not apply to children under age 19.
Calendar Year Deductible $0 $50/person; $100/family
Co-Insurance (Category I) 100% of covered expenses 85% of covered expenses
Co-Insurance (Category II) 80% of covered expenses 60% of covered expenses
Co-Insurance (Category III) 70% of covered expenses 50% of covered expenses
Orthodontia No deductible; 50% of covered expenses; Coverage only available for dependent children under age 19; Lifetime maximum payment of $1,500 per dependent child.

DELTA DENTAL'S WELLNESS LIBRARY

Delta Dental’s Wellness Library connects participants to dental resources all year long through relevant articles on topics, including dental care for cold and flu season, retainer care, and even the dental dangers of sports. Sort library articles by oral health categories to make finding new information and helpful reminders easy. Explore Delta Dental’s Wellness Library here.

ORAL HEALTH WEBINAR SESSIONS

Delta Dental’s educational webinars give participants the information they need to prioritize their oral health. Some engaging webinar topics include gum health and oral health. Click here to view future webinar dates and times or to register.

FILING A DENTAL CLAIM

When you visit a Delta Dental dentist, your dentist should take care of your claim. However, if you go to a non-Delta Dental dentist, you will need to file your claim with Delta Dental.

STEP-BY-STEP INSTRUCTIONS

Step 1: Fill out sections 1 – 15 of the Dental Plan Claims Form

  • For Section 9, Employer (Company) Name, write in “DGA-PPHP.”
  • For Section 10, Group Number, write in “0480.”

Step 2: Attach a copy of the dentist’s statement of treatment to the claim form.

The statement of treatment should include the dentist’s name, phone number, a description of each service the dentist performed, and the amounts billed and paid for each service.

Step 3: If you do not have a U.S. social security number…

…you can either call our office for the alternate social security number we assigned to you for identification purposes or enter your “Enrollee Number” which appears on your Delta Dental coverage card.

Step 4: Submit your claim.

Mail your claim directly to Blue Cross at the address below:

Delta Dental
P.O. Box 997330
Sacramento, CA  95899-7330