Dental

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The dental plans offered by PCOC are designed to assist you and your covered dependents by paying a portion of eligible expenses incurred for a wide range of dental services. The dental plans are insured by Delta Dental.

  • If you enroll within your initial eligibility period, your coverage will be effective on the first of the month coinciding with or next following 30 days of full-time employment.
  • If you do not enroll for coverage within your initial eligibility period, you may enroll for coverage during the next annual open enrollment period or within 31 days of a qualifying event (as outlined in Making Changes During the Year).

Your Cost

Your cost is generally deducted from your pay on a pretax basis. Contributions for domestic partners are generally deducted on an after-tax basis, unless otherwise permitted by state or federal law. Refer to Employee Contributions for the applicable cost.

Find a Dentist

Click here to find a Dentist in your area and follow the steps below:

  1. Select your Specialty Selection: General Dentist, Oral Surgeon, Orthodontist, etc.
  2. Select Your Plan: Delta Dental PPO or DeltaCare USA (HMO plan)
  3. Search by Location: Current Location or Zip Code, City, or Address
  4. Select More Options: (Optional)
  5. To receive the highest discounts, be sure to select a dental provider that participates in your plan’s network

The following table summarizes the key features of the 2024 dental plans available to you and your eligible dependents. To receive the highest level of benefits, you should use in-network providers and fully understand what is expected of you.

PCOC Dental Plans
Key Features*
Calendar Year Maximum (per person)
Lifetime Orthodontia Maximum
Calendar Year Deductible (ded.)
Individual
Family
Diagnostic and Preventive Services
Exams, x-rays, cleanings, fluoride treatments, space maintainers
Basic Restorative Services
Fillings, simple tooth extractions, sealants
Endodontics and Periodontics Services
Root canals and gum treatment
Major Services
Oral surgery, root canal therapy, crowns, inlays, onlays, dentures, bridges
Orthodontia Services
PCOC Dental Plans
Option 1
Delta Dental PPO**
In-Network
$1,500
$1,000
You Pay

-
$50
$150
0%
20% after ded.
20% after ded.
50% after ded.
50% (Children only)
PCOC Dental Plans
Option 1
Delta Dental PPO**
Out-of-Network
$1,500
$1,000
You Pay

-
$50
$150
20%
20% after ded.
20% after ded.
50% after ded.
50% (Children only)
PCOC Dental Plans
Option 2
DeltaCare USA HMO***
In-Network only
None
None
You Pay

-
None
None
No copay for most services
Copays ranging from
$5 to $295
Copays ranging from
$0 to $310
Copays ranging from
$5 to $310
Copays ranging from
$25 to $1,900

*Limitations and exclusions may apply to some benefits.
**Reimbursement is based on the lesser of the dentist’s submitted fees or the PPO contracted fees for PPO dentists, the Premier contracted fees for Premier dentists, the plan allowance for non-Delta Dental dentists. You will save the most money when visiting a Delta Dental PPO dentist. Delta Dental Premier dentists’ contracted fees are usually slightly higher than Delta Dental PPO contracted fees.
***The DeltaCare USA HMO plan uses a patient charge schedule to determine covered procedures and patient charges. Contact Delta Dental member services for the most recent copy of the patient charge schedule.

This summary is provided for general information only. Refer to the specific plan documents available on Forms and Documents for detailed information on complete plan provisions, exclusions and limitations.

Website Access

The plans also offer additional value-added benefits. After registering on the Delta Dental website, you will be provided with the online tools to:

  • Find a network dentist and receive driving directions.
  • Verify eligibility and view benefit information and claim history.
  • Download claim forms.
  • Find the average cost of a dental procedure in your area.
  • Access dental tips, videos, kid activities, recipes and other oral health information.
  • Contact customer service and subscribe to online services.
  • Get answers to frequently asked questions.

Additional Dental Resources

Delta Dental’s wellness library at deltadentalins.com/wellness.html offers information, activities and tools to help you protect your teeth. In addition, you can register for the free dental health e-magazine, Grin, which provides valuable information about dental health topics and how to maximize your benefits.

Delta Dental Website

www.deltadentalins.com

First time visitors: You will need to establish a user ID and password.
Then, information is available 24/7.

Member Services
DeltaCare USA HMO or Delta Dental PPO

Group# PPO: 7481-5614 DHMO: 73001-00180

(800) 765-6003

www.deltadentalins.com

Questions or need help?
Contact the PCOC Benefits Service Center

(855) 726-2291

pcocbenefits@teamcreativa.com

Dental Forms and Documents