Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates
Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates
Summary of Dental Benefits and Coverage Disclosures Matrix (SDBC) Document Library - California
| Plan name | Group | Division |
|---|---|---|
| Delta Dental Individual & Family™ Delta Dental PPO™ Family Dental PPO * (2023 version) | 50037 | 10004 |
| Delta Dental Individual & Family™ DeltaCare® USA Family Dental HMO ** (2023 version) | 78637 | 00024 |
| Delta Dental PPO™ Children's Dental PPO for Small Businesses * (2023 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| Delta Dental PPO™ Family Dental PPO for Small Businesses * (2023 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| DeltaCare® USA Children's Dental HMO for Small Businesses ** (2023 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| DeltaCare® USA Family Dental HMO for Small Businesses ** (2023 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| Delta Dental Individual & Family™ Delta Dental PPO™ Family Dental PPO * (2024 version) | 50037 | 10004 |
| Delta Dental Individual & Family™ DeltaCare® USA Family Dental HMO ** (2024 version) | 78637 | 00024 |
| Delta Dental PPO™ Children's Dental PPO for Small Businesses * (2024 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| Delta Dental PPO™ Family Dental PPO for Small Businesses * (2024 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| DeltaCare® USA Children's Dental HMO for Small Businesses ** (2024 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| DeltaCare® USA Family Dental HMO for Small Businesses ** (2024 version) | This plan is associated with a number of Groups/Divisions and are not listed here. | |
| Plan name | Group | Division |
|---|---|---|
| DeltaCare® USA – CAA50 Senior Program ** (2023 version) | 70530 | 00002, 00004, 00005, 00006, 01005 |
| DeltaCare® USA – CAA55 ** (2023 version) | 70116 | 00008 |
| DeltaCare® USA – CAB54 ** (2023 version) | 70116 | 00009 |
| Delta Dental PPO™ – Individual Basic *** (2023 version) | 18818 | 00004 |
| Delta Dental PPO™ – Individual Premium *** (2023 version) | 18818 | 00005 |
| DeltaCare® USA – CAA50 Senior Program ** (2024 version) | 70530 | 00002, 00004, 00005, 00006, 01005 |
| DeltaCare® USA – CAA55 ** (2024 version) | 70116 | 00008 |
| DeltaCare® USA – CAB54 ** (2024 version) | 70116 | 00009 |
| Delta Dental PPO™ – Individual Basic *** (2024 version) | 18818 | 00004 |
| Delta Dental PPO™ – Individual Premium *** (2024 version) | 18818 | 00005 |
| Plan name | Group | Division |
|---|---|---|
| 15B DeltaCare® USA ** | 76777 / 76976 | 01001 |
| Delta Dental PPO Plan A **** | 01230 / 17104 | 00501 |
| Delta Dental PPO Plan B **** | 01230 / 17104 | 00502 |
| Plan name | Group | Division |
|---|---|---|
| Individual/ Family Dental Plan - CAE01 ** (2023 version) | 76444 | 00001 |
| DeltaCare® USA – CAE01 ** (2024 version) | 76444 | 00001 |
If you live in CA and would like a paper copy of the Summary of Dental Benefits and Coverage Disclosure Matrix SDBC, free of charge, please call our Contact Center at 888.282.9501.
The SDBCs are just summaries. Review the plan booklet and disclosure form for a complete description of benefits, limitations and exclusions.
*In CA, Delta Dental PPO is underwritten by Delta Dental of California.
Please refer to the policy and disclosure form for a complete list of plan benefits, limitations and exclusions.
**In CA, DeltaCare USA is underwritten by Delta Dental of California and administered by Delta Dental Insurance Company. These companies are financially responsible for their own products.
Please refer to the policy and disclosure form for a complete list of plan benefits, limitations and exclusions.
***In CA, Delta Dental PPO is underwritten by Delta Dental of California and administered by Delta Dental Insurance Company.
Please refer to the policy and disclosure form for a complete list of plan benefits, limitations and exclusions.
****In CA, the AARP® Dental Insurance Plan is insured by Dentegra Insurance Company (Contract 1230) and administered by Delta Dental Insurance Company. These companies are financially responsible for their own products.
Please refer to the plan COC and disclosure form for a complete list of plan benefits, limitations and exclusions.
AARP endorses the AARP Dental Insurance Plan, administered by Delta Dental Insurance Company. Delta Dental Insurance Company pays royalty fees to AARP for use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers.