When you designate and use your in-network primary care dentist (PCD,) you will be responsible for only paying copays that vary per procedure. There are no deductibles or coinsurance when you use your designated PCD.
If your PCD is unable to perform the procedure, your PCD will coordinate your care with a specialist. If you visit an in-network specialist and have a designated PCD, the plan will cover 25% of the specialist’s usual and customary charges. If you don’t have a designated PCD and you visit a specialist, you will be responsible for the full cost. Be sure to designate a PCD as soon as possible.
The plan is available to Texas Employees Group Benefits Program (GBP) eligible employees, retirees and dependents. Evidence of Insurability is never required to enroll in this plan.
- You and your dependents must enroll in the same dental plan.
- You can enroll in this plan during your first 31 days of employment. There is no waiting period.
- You can also enroll when you have a qualifying life event (QLE), such as a birth or marriage, and coverage will begin on the date of birth or the first of the month following the event.
You receive two covered exams per year at no cost to you and two cleanings per year for $12 each. Orthodontic coverage is available to adults and children.
Want more information about this plan? Review the following for details.
The DeltaCare USA plan gives you comprehensive coverage with no waiting period, annual maximum or deductible. You’ll have a list of copayments for every covered procedure so you’ll know all your costs — for preventive, basic and major services — up front. Preventive care, like routine cleanings and exams, is covered at low or no cost.
Get answers to common questions about the DeltaCare USA plan.
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DeltaCare USA dentists will handle all claims and paperwork for you. However, if you visit a non-DeltaCare USA dentist, you may need to file the claim yourself. Learn how to file a DHMO claim.
Please note: Your DHMO plan requires that you visit a DeltaCare USA network dentist, who will handle your claims. If you need emergency care and are away from your designated DeltaCare USA primary care dentist (PCD), you will have to pay for services and submit a claim form to request reimbursement. Please refer to your Evidence of Coverage (EOC) (PDF, 1.1 MB) for specific coverage details and procedures.
1 DeltaCare USA is underwritten in Texas by Alpha Dental Programs, Inc. and administered by Delta Dental Insurance Company.