Dental Care

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. 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.

Dental Plan Information

Policy Information

Benefit Summary

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.

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

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Dental Care

Dental Plan Information

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