Delta Dental (PPO)

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Delta Dental offers four provider options, which generally offer cost savings as follows:

  • Ostrow School of Dentistry of USC and Faculty Practice – your best cost savings
  • Delta Dental PPO dentists – the next highest cost savings
  • Delta Dental Premier dentists – offer contracted rates that help you save, but not as great a savings as the PPO providers
  • Non-contracted dentists – lowest benefit

The maximum annual benefit paid under Delta Dental for each covered person is $1500.

Ostrow School of Dentistry and Faculty Practice is located on the University Park campus in the Engemann Student Health Center building (1031 West 34th Street, ESH 326, Suite 401 – yellow building in center of graphic, above). Limited complimentary parking is available. The faculty practice is a full service dental practice including all specialties (general, prosthodontics, endodontics, periodontics, orthodontics, oral surgery and cosmetic), and all dentists are members of the faculty (no students work at this practice, although they do work in the Ostrow School of Dentistry clinics). Limited early morning and lunchtime appointments are available, as well as some late afternoon/early evening and Saturday hours. Emergency dental care is available to existing patients.

For services provided by a Delta Dental PPO dentist, a $50 per person annual deductible applies, up to a limit of $150 per family. For services provided out of PPO network, a $75 per person annual deductible applies, up to a limit of $225 per family.

Reimbursement is based on PPO-contracted fees for PPO dentists, Premier-contracted fees for Premier dentists and program allowance for non-Delta Dental dentists. The plan pays eligible dental expenses as follows:

  • 100% (no deductible) for diagnostic and preventive services (such as exams, two cleanings per calendar year, fluoride treatment, and space maintainers) at the Ostrow Faculty Practice and School of Dentistry. For all other in-network PPO dentists, 90% coverage (no deductible) and 80% coverage (no deductible) for Delta Premier dentists.
  • 100% after deductible for basic services such as oral surgery, fillings, endodontics, periodontics, and sealants at the Ostrow Faculty Practice and School of Dentistry. For all other in-network PPO dentists, 80% after deductible.
  • 100% after deductible for major services such as crowns, inlays, onlays and cast restorations, fixed bridges, and dentures at the Ostrow Faculty Practice and School of Dentistry. For all other in-network PPO dentists, 60% after deductible.
  • 50% for implants up to a lifetime maximum of $1500
  • 50% for orthodontics up to a lifetime maximum of $1500

If you use a non-Delta Dental dentist who charges more than Delta’s program allowance for a service, you must pay the additional cost. To verify a dentist’s participation in Delta Dental, call customer service at (800) 765-6003 and be sure to reference the USC group number, 03378-03001. Or you can search for a provider online (note you may have to disable popup blockers to use the Delta online search function).

Delta ID cards in the employee’s name are sent to all enrollees – those with family coverage get two cards (you may also verify benefits and pay claims using your SSN, if you wish). Additional cards may be obtained at the Delta Dental website or by calling them at (888) 335-8227.

Delta Dental – Benefits Summary – 2017
Delta Dental Claim Form
Coordination of Benefits
Delta Dental Evidence of Coverage 2016

Notice of Privacy Practices

Delta Dental | deltadentalins.com
(888) 335-8227