DENTAL INSURANCE

 

City employees may choose from three dental options administered by Delta Dental.

1. Delta Dental Preventive Only
Member Services: 800-765-6003
Provides preventive dental care only. Those who choose this option receive an additional $5.00 per month of taxable income for full-time employees and $2.50 per month for half-time employees.

2. DeltaCare USA DHMO (HMO)
Member Services: 800-422-4234
Plan requires you see your Primary Care Dentist (PCD) first whenever you need care.

3. Delta Dental PPO (PPO)
Member Services: 800-765-6003
Provides care through a network of dentists who have agreed to offer covered services at discounted rates.

Delta Dental Links

Delta Dental Website Delta Dental Mobile App

Information Found on this Page

Dental Plan Comparisons

General Dental Plan Comparison

The table below displays a few highlights of your dental benefit options. For more information about your coverage, log in to your Delta Dental account and view “Benefit Details.”

Delta Dental
Preventive Only		 DeltaCare USA DHMO Delta Dental PPO
Features a network of providers Yes Yes Yes
Offers flexibility to use non-network providers Yes No Yes - paid at
out-of-network level
Covers preventive care Yes Yes Yes
Covers services other than preventive care
such as basic and major services		 No Yes Yes
Has a calendar year deductible No No Yes
Has an annual maximum benefit No No Yes
Includes set copays for most services No Yes No
Requires you to choose a primary care dentist No Yes No
Covers emergency care outside the
provider network*		 No Yes - up to $100 per
incident after any copay**		 Yes - paid at
out-of-network level
* For emergency care provided by a dentist who is not part of Delta’s network, you must pay for services and submit a claim. For claim instructions, contact Delta Dental Customer Service at 800-765-6003 for PPO or 800-422-4234 for DeltaCare USA DHMO. 

** Contact your primary care dentist (PCD) or Delta Dental Customer Service at 800-422-4234 before receiving treatment. If you do not, you may be responsible for any charges related to treatment.

 

Dental Plan Services, Copays, and Deductible Comparison

The table shows a brief summary of how the three dental options pay for certain services.

How Benefits Are Paid Delta Dental
Preventive Only		 DeltaCare USA DHMO Delta Dental PPO
In-Network Out-of-Network****
Calendar Year Deductible None None $25/person; $75/family $50/person; $150/family
Diagnostic and Preventative Care
Two cleanings and
exams/year

Two sets of bitewing X-rays/year for children up to age 18; one set/year for adults

Two fluoride treatments/year for children up to age 19 (not covered by Preventive Only)		 Plan pays 100% in-network or 100% of R&C* out-of-network (includes an additional oral exam and routine cleaning during pregnancy) Plan pays 100% — covers one series of four bitewing X-rays in any six-month period for children or adults Cleanings, X-rays and exams: Plan pays 100% with no deductible (includes an additional oral exam and a routine cleaning during pregnancy). Diagnostic and Preventive Care charges are not applied to the annual maximum. Cleanings, X-rays and exams: Plan pays 80% of R&C* with no deductible (includes an additional oral exam and a routine cleaning during pregnancy). Diagnostic and Preventive Care charges are not applied to the annual maximum.
Basic Services
Amalgam fillings, extractions Not covered Plan pays 100% for fillings; you pay up to $90 for extractions Plan pays 80% Plan pays 80% of R&C*
Root Canal Not covered Your copay is $45 – $220 per procedure Plan pays 80% Plan pays 80% of R&C*
Periodontal scaling and root planing Not covered Plan pays 100% up to 4 quadrants in 12 months Plan pays 80% once per quadrant every 24 months Plan pays 80% of R&C,* once per quadrant every 24 months
Major Services
Crowns Not covered Your copay is $55 – $195 per procedure** Plan pays 80% Plan pays 50% of R&C*
Dentures Not covered Your copay is $80 – $170 per procedure Plan pays 50% Plan pays 50% of R&C*
Implants Not covered Not covered Plan pays 50% Plan pays 50% of R&C*
Orthodontia
Children under age 19 Not covered Your copay is $1,000 plus start-up fees of $300 Plan pays 50% Plan pays 50% of R&C*
Children age 19 to age 26 Not covered Your copay is $1,350 plus start-up fees of $300 Plan pays 50% Plan pays 50% of R&C*
Adults Not covered Your copay is $1,350 plus start-up fees of $300 Not covered Not covered
Plan Maximums
Annual maximum benefit (does not include diagnostic and preventive services) Not applicable None $1,500/person***
Lifetime orthodontia maximum benefit Not covered None $1,500/child
* R&C is the reasonable and customary charge – the usual charge for specific services in the geographic area where you are treated.

** When there are more than six crowns in the same treatment plan, an enrollee may be charged an additional $100 per crown beyond the sixth unit. 

*** If you use both in-network and out-of-network dentists, your total annual maximum benefit will never be more than $1,500 per person.

**** Employees accessing out-of-network services may be required to pay for services in full and submit claims directly to Delta Dental for reimbursement. The employee is also required to ensure their payments for services are accurate.

Your Dental Dental Plan Premium Costs

How Your Costs are Determined

The amount of premium you are responsible for is determined by:

  1. Your employment status (full-time or half-time)
  2. The specific dental plan you choose
  3. The coverage level you choose. The coverage levels are:
  • Employee Only (Single Party – Employee)
  • Employee & Spouse/Domestic Partner (DP)* (Two Party – Employee and another adult legal spouse or legal DP)
  • Employee + Child(ren) (Two+ Party – Employee and any legal child and/or disabled child dependents in the household)
  • Employee + Family* (Three+ Party – Employee and all legal dependents)

*Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment of the employee. Visit Domestic Partnership for further details.

City Subsidy

The majority of dental insurance premium costs (for employee-only coverage) are paid by the City’s subsidy. However, the City’s subsidy is subject to eligibility. The employee portion of the premiums, if any, is automatically deducted from your paychecks two times per month.

  • The City’s maximum DHMO dental plan subsidy is $15.94 per month for all employees.
  • The City’s maximum PPO dental plan subsidy is $42.93 per month for full-time employees and $25.25 per month for half-time employees.

Subsidy Eligibility Your eligibility to receive the City’s subsidy for your benefits is evaluated on a biweekly basis. For more information see the Employee Eligibility page.

 
 

2025 Premium Costs

Full-Time Employees

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Half-Time-Time Employees

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

2024 Premium Costs

Full-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $6.21 ($2.50)**^** $3.71
Employee & Spouse/DP**^^** $3.71 $3.09 $6.80
Employee + Child(ren)**^^** $3.71 $3.91 $7.62
Employee + Family**^^** $3.71 $7.30 $11.01
DeltaCare USA DHMO
Employee Only $7.97 $0.00 $7.97
Employee & Spouse/DP**^^** $7.97 $6.89 $14.86
Employee + Child(ren)**^^** $7.97 $5.36 $13.33
Employee + Family**^^** $7.97 $9.25 $17.22
Delta Dental PPO
Employee Only $21.46 $3.79 $25.25
Employee & Spouse/DP**^^** $21.46 $25.89 $47.35
Employee + Child(ren)**^^** $21.46 $27.63 $49.09
Employee + Family^^ $21.46 $44.39 $65.85

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Half-Time-Time Employees

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

2023 Premium Costs

Full-Time-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $6.29 ($2.50)**^** $3.79
Employee & Spouse/DP**^^** $3.79 $3.15 $6.94
Employee + Child(ren)**^^** $3.79 $4.00 $7.78
Employee + Family**^^** $3.79 $7.45 $11.24
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP**^^** $8.39 $7.25 $15.64
Employee + Child(ren)**^^** $8.39 $5.64 $14.03
Employee + Family**^^** $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $21.91 $3.86 $25.77
Employee & Spouse/DP**^^** $21.91 $26.40 $48.31
Employee + Child(ren)**^^** $21.91 $28.18 $50.09
Employee + Family**^^** $21.91 $45.29 $67.20

Half-Time-Time Employees

Coverage Level City Pays... Full-Time Employees Pay... Total Cost of Coverage
Biweekly (per Pay Period)
Delta Dental Preventative Only
Employee Only $3.79 ($1.25)**^** $3.79
Employee & Spouse/DP**^^** $3.79 $3.15 $6.94
Employee + Child(ren)**^^** $3.79 $4.00 $7.78
Employee + Family**^^** $3.79 $7.45 $11.24
DeltaCare USA DHMO
Employee Only $8.39 $0.00 $8.39
Employee & Spouse/DP**^^** $8.39 $7.25 $15.64
Employee + Child(ren)**^^** $8.39 $5.64 $14.03
Employee + Family**^^** $8.39 $9.73 $18.12
Delta Dental PPO
Employee Only $12.89 $12.88 $25.77
Employee & Spouse/DP**^^** $12.89 $35.42 $48.31
Employee + Child(ren)**^^** $12.89 $37.20 $50.09
Employee + Family**^^** $12.89 $54.31 $67.20

^ Additional LAwell dollars credited to employee.
^^ Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment.

Access Dental Services

To Find a Network Provider

Go to Delta Dental, under “Find a Dentist”, enter your zip code and from the drop-down menu, choose your dental plan.

Register for a Delta Dental online account

There you can verify eligibility, your enrolled family members, claim status, your Primary Care Dentist (PCD) and other benefit specifics.

  1. Go to Delta Dental

  2. Select “Log in” at the top right side of the page.

  3. Select “Create an account.” 

  4. Select “Enrollee/Adult Dependent” from the drop-down menu. Then select “Next.”

  5. Enter your personal information.