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Costco/Delta Dental
of California
(Dental HMO Plan)
Enrollment Form
Evidence of Coverage
Disclosure Form
Overview of Benefits
Costco Health
Insurance Program
Current Location: Costco/Delta Dental of California (Dental HMO Plan)
 
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Introducing a plan designed exclusively for Costco Executive Members!
     

Enrolling is easy as 1, 2 and 3!

Complete the DeltaCare USA enrollment form, acknowledge you understand the plan details and submit payment. All Executive members are approved, and there is no pre-screening required. Join by the 21st of the month and begin to use your dental benefits by the first of the next month. With premiums starting as low as $89 per year, you can start taking advantage of the following benefits:

  • No waiting period for covered benefits
  • No claims forms to complete
  • No deductibles
  • No calendar year maximums
  • Copayments are the same for covered services performed by a general dentist or referred specialist.
  • Orthodontic care
  • Coverage for certain cosmetic procedures such as bleaching.
  • Coverage for composites on posterior teeth at set copayments
  • General anesthesia benefit for certain dental procedures

See this page for a overview of covered benefits.

Renew coverage

You are able to renew coverage online from 90 days before the coverage termination date and up to 15 days after the termination date.

If your coverage has been terminated for more than 15 days, please contact Customer Service to renew.

Delta Dental Customer Service Department: (800) 422-4234

If you are not currently a Costco Executive Member, please contact Costco at (800) 220-6000 to upgrade your membership today.

Note: This program, offered and administered by Delta Dental of California, is currently available only in California.

   
 

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