DeltaCare USA DHMO

DeltaCare DHMO: Plan Details

DeltaCare USA DHMO

HMOs, or Health Maintenance Organizations, are copay based and cover services performed solely by providers within their network (with the exception of emergency services).

Deductibles & Copays

Deductibles & Copays:

  • There is no deductible for this plan.
  • Most services are covered at no cost (please review the Evidence of Coverage for details).
  • Deductibles and copays are waived if accessing preventive care services.

Print a Temporary ID Card

How to Print a Temporary Delta Dental DHMO ID Card:

  1. Visit Delta Dental's website at www.deltadentalins.com and login.
    • If this is the first time logging in, you will need to register first.
  2. Once you have logged in, click the Eligibility & Benefits tab and select the "Print ID Card" option.

Provider Information

Provider Information:

This plan uses a provider network. You may only access services from providers who are in the DeltaCare USA HMO network.

  • You are required to select a primary care dentist. For a complete list of providers, please visit the Delta Dental website at www.deltadentalins.com. If you do not choose one at the time of enrollment, then one will be assigned to you, but you may change your primary care dentist by contacting DeltaCare USA's member services line at (800) 422 - 4234.

Detailed Benefits & Coverage Information

Benefits & Coverage Information:

Dental Plan Comparison Chart

Service Delta Dental DPPO DeltaCare USA DHMO
Annual Deductible $50 Per Individual
$150 Per Family		 No Deductible
Maximum Benefits Allowed $2,500
Per Individual Per Year		 No Annual Maximum
Preventative Services PPO Provider: 0%
Non-PPO Provider: 10%		 $0 for Most Services
Basic Services PPO Provider: 10%
Non-PPO Provider: 10%		 $0 for Most Services
A copay may be required for upgraded materials and services
Major Services
(Including Periodontics, Endodontics, and Oral Surgery)		 50% $0 for Most Services
A copay may be required for upgraded materials and services.
Orthodontia (Adult) $1,880 Copay* $1,900 Copay
Orthodontia (Child) $1,660 Copay* $1,700 Copay
Additional Orthodontia Information *Once per lifetime With a maximum of 24 months of treatment. Pre and post-treatment services have additional copayments.

Visit deltadentalins.com to search for an in-network provider.

 

Health Plan Contact Information

Delta Dental Member Services
Phone: (800) 765 - 6003

 

Human Resources - Employee Benefits Division

Phone:(559) 600 - 1810
Email:HRBenefits@fresnocountyca.gov
Fax:(559) 455 - 4787

Address*:2220 Tulare St., Suite 1400, Fresno, CA 93721

*Please note that Employee Benefits is not responsible for any lost or stolen mail,
nor mail received after the deadline. All paperwork and supporting documentation
must be received by the Employee Benefits office prior to any deadlines.
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