To help you maintain good overall health, we provide a choice of two dental plans: Delta Dental Basic and Delta Dental Enhanced.
Dental care coverage for both plans:
- Includes diagnostic and preventive checkups and cleanings
- Includes coverage for basic and major services
- Provides benefits through Delta Dental's network of dentists
Choosing a PPO dentist is the most cost effective use of your dental benefits.
To learn more about the plans so you can choose the one that's right for you:
Our Delta Dental plans provide a broad array of dental services, but like any policy, there are certain exclusions and limitations as well as amounts you must pay out-of-pocket.
If you have any questions about whether certain procedures will be covered, contact Delta Dental at 800-765-6003.
In addition, you can ask your dental provider to file a pre-treatment estimate with Delta Dental for any basic or major services that may exceed $300. Delta Dental will review the pre-treatment estimate against your benefits to determine covered services and estimated costs before treatment begins.
Delta Dental Basic
We cover the entire cost of the Basic PPO plan for full-time employees. The plan does not include orthodontic treatment and coverage for implants.View details about the Delta Dental Basic plan
Delta Dental Enhanced Plan
This plan requires an employee contribution, but provides a higher level of coverage for some services when you use Delta Dental PPO providers. The Enhanced PPO plan includes orthodontic treatment and coverage for implants.View details about the Delta Dental Enhanced plan
What are the differences between Delta Dental Basic PPO and Delta Dental Enhanced PPO?
With Delta Dental Basic PPO, if you use a dentist from Delta’s PPO network you are reimbursed at a contracted amount based on usual and customary (U&C) fees. You also have the option of going to a dentist outside the network. When you go outside the network, you pay any difference between Delta’s U&C and the amount your dentist charges. This plan does not cover orthodontia or dental implants.
The Delta Dental Enhanced PPO allows you to choose a dentist in or out of the Delta network, but pays more when you stay in-network. This plan has a higher annual maximum benefit than Delta Dental Basic PPO does, and it covers orthodontia and dental implants. If you use a PPO network dentist your annual maximum benefit is $3,000, otherwise it is $1,500 for Premier or non-network dentists. Please note that if you use a PPO network dentist first and subsequently a Premier or non-network dentist the cost of your PPO provider services counts toward the $1,500 Premier or non-network annual maximum limit.
Delta Dental's standard payment practice for reimbursement of orthodontic services is to pay the lifetime maximum over two installments. The first coming when the initial claims is processed and the second 12 months later. Depending upon the date orthodontic services were received and the claim processed the second payment may not occur until the next plan year. You must remain enrolled in the Enhanced plan in the year the second installment is paid otherwise Delta Dental will not issue the second payment.
For more information on commonly covered services and your costs, see the dental plan comparison chart or view the individual summary plan descriptions for Delta Basic PPO and Delta Dental Enhanced PPO.
Do Stanford's Delta Dental Plans cover all dental services?
Like any policy, with Delta Dental plans there are certain exclusions and limitations as well as amounts you must pay out-of-pocket. You can obtain information on the specific and general exclusions and limitations,* and other policy provisions by reading the summary plan descriptions:
If you have any questions about whether certain procedures will be covered, contact Delta Dental at (800) 765-6003.
In addition, you can ask your dental provider to file a pre-treatment estimate with Delta Dental for any basic or major services that may exceed $300.
*EXCLUSIONS AND LIMITATIONS
All of the dental policies pertaining to Stanford’s Delta Dental plans include general and specific exclusions and limitations. This means certain dental services are not covered under the policy. Also, coverage for certain covered dental services are subject to conditions and other limitations, such as the number of times they may be covered in a given time period. We encourage you to review these exclusions and limitations prior to enrollment.
Below are some examples of exclusions and limitations. For a full list, review the summary plan descriptions.
Under any** Delta Dental plan, you are eligible for:
- An oral examination twice in a calendar year
- Full-mouth x-rays once in a five-year period
- Two cleanings or a dental procedure that includes a cleaning each calendar year
- Fluoride treatments twice each calendar year
**ANY DELTA DENTAL PLAN INCLUDES THE CURRENT STANFORD DENTAL PLAN YOU ARE ENROLLED IN AND ALL PRIOR DELTA DENTAL COVERAGE WHETHER THROUGH STANFORD OR ANOTHER EMPLOYER.
How do I find out if my dentist is in the Delta network?
Visit the Delta Dental website or call Delta Dental toll free at (888) 335-8227.
Do I need preauthorization for treatment?
After an examination, your dentist will talk to you about treatment you may need. The cost of treatment is something you may want to consider. If the service is extensive and involves crowns or bridges, or if the service will cost more than $300, we encourage you to ask your dentist to request a pre-treatment estimate.
A pre-treatment estimate does not guarantee payment. It is an estimate of the amount Delta will pay. A pre-treatment estimate helps prevent any misunderstanding about your financial responsibilities. If you have any concerns about the pre-treatment estimate, contact Delta before treatment begins.