The California State University Dental Plans Summary

January 1, 2007– December 31, 2008

Your CSU Dental Program consists of two types of plans: Delta Dental PPO and DeltaCare USA

This summary provides the most important features of each dental plan offered by the university.  It is designed to help you select the plan that best suits your personal needs.  The Evidence of Coverage (EOC) booklet provides a detailed explanation of benefits, services, limitations and exclusions.  A copy of the EOC booklet is available online at www.deltadentalca.org/csu, or can be obtained from the Benefits Office.

Explanation of Plan Types

Delta Dental PPO, is an indemnity plan that allows you to select the dentist of your choice.  Your current dentist may participate in the Delta Dental PPO Network and/or the Delta Dental Premier Network in California.  If so, he/she has claim forms and will file your claim.  Both you and Delta have a shared responsibility of paying the dentist for services received (see appropriate comparison chart).  If you choose a non-Delta dentist, you must pay entirely for services obtained and then submit a claim form with appropriate documentation to Delta Dental PPO for reimbursement. Claims should be sent to: P.O. Box 997330, Sacramento, CA 95899-7330.  Refer to the EOC booklet for coverage details and plan limitations. Benefits described in this comparison are guaranteed only when you select a participating dentist from Delta’s networks. 

DeltaCare USA, is a prepaid dental maintenance organization, which means that  all covered dental care for you and your dependents is prepaid and must be performed by DeltaCare USA panel dentists. (You may change dentists by contacting DeltaCare USA.)  Under this plan, each covered dental service has a specific co-payment amount, and some services are covered at no charge. No claim forms are required, and you will receive an identification card which you show your dentist to receive benefits. All covered dental services deemed necessary by your dentist will be provided subject to plan limitations explained in the EOC booklet.

Definition of Terms

 Below are definitions of dental plan terminology:

Endodontics

Treatment involving tooth pulp, such as a root canal.

Extractions

Removal of teeth.

Oral Surgery

Extractions and certain surgical procedures, including pre/post-operative care.

Orthodontics

Treatment to correct position or alignment of teeth, such as braces.

Periodontics

Treatment of gums and bones supporting teeth.

Prophylaxis

Scaling and cleaning of teeth.

Prosthetics

Replacement for teeth, such as crowns, dentures, or bridges.

Co-payment

A fee the member pays for a service.

Indemnity Plan

Where the member has free choice of dentists.  A claim form is required.

Prepaid Plan

Members use dentist contracting with the plan.  No claim forms are required.

UCR

UCR (Usual, Customary, and Reasonable) applies to the Delta Dental plan only.  This is the fee that a Delta dentist usually charges for a particular service, or the fee that is customarily charged by Delta dentists in the geographical area.