All those enrolled in the University of California Student Health Insurance Plan (UC SHIP) are automatically enrolled in the dental care coverage through Delta Dental. Your Delta Dental "Enrollee ID" is the same member ID as your Anthem ID excluding the pre-fix "XDP". A referral is not needed to access dental benefits; you only need to find a Delta Dental PPO Provider, provide the dental offce with your "Enrollee ID", and schedule your appoinment.
UCSF Dental Center provides comprehensive dental care for adults and children. The highest level of benefit is with a Delta Dental PPO network provider. Before seeking care please confirm with the dental office if they are Delta Dental PPO network provider. Delta Dental Premier network providers and out-of-network providers will result in higher out-of-pocket expenses.
| Billing | Delta Dental of California
P.O. Box 997330
Sacramento, CA 95899-7330
Tel: 1-800-765-6003 |
| Member ID | Register with Delta Dental using your Anthem ID (excluding the “XDP”) as your "Enrollee ID” |
| Group Policy | 20096 |
| Annual Deductible: | $25 in-network / $50 out-of-network |
| Annual Maximum Benefit: | $1000 in-network / $750 out-of-network |
Diagnostic and Preventative Services
(exams, cleanings, x-rays) | 100% in-network / 80% out-of-network |
Basic Services
(fillings, simple tooth extractions, sealants) | 80% in-network / 60% out-of-network |
| Endodontics (root canal) | 80% in-network / 60% out-of-network |
| Periodontics (gum treatment) | 80% in-network / 60% out-of-network |
| Oral Surgery (gum treatment) | 80% in-network / 60% out-of-network |
Major Services
(crowns, inlays, onlays and cast restorations, bridges, and dentures) | 70% in-network / 40% out-of-network |
| *Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Dental Benefit Booklet or Summary of Benefits for waiting periods and a list of benefit limitations and exclusions. |
| **Fees are based on PPO fees for in-network dentists and the maximum plan allowance (MPA) for out-of-network dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist's actual fees. |
