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Below explanation is for California plan only

Delta Dental logo  DeltaCare USA Dental HMO plan 
Toll free (877)566-5454
When you enroll in DeltaCare USA, you select a PMI network dentist to provide your dental care. With DeltaCare USA, you must visit your selected primary care dentist in order to receive benefits. When you need specialty care, your primary care dentist can obtain a referral. Advantages of the DeltaCare USA plan include low or no copayments for services, no deductibles and no maximums on services provided by primary care dentists.
DeltaCare USA RATES (ALL under age 65)
 
Plan CAA54
Plan CAA55
 Individual Annual Premium $101.80 $ 90.76
 Individual +1 dependent $158.53 $140.68
 Individual +2 or more dependents $227.56 $201.16
 
  You pay more up front with a higher annual premium.

You pay lower copayments on certain procedures.
You pay less up front with a lower annual premium.

You pay higher copayments on certain procedures.
Sample of Covered Procedures You pay You pay
 Office Visit
$10
$15
 Exam
No cost
No cost
 Bitewing X-rays
No cost
No cost
 Full Mouth X-rays
No cost
No cost
 Cleaning (once every 7 months)
$20
$25
 Crown (upgrade charges may apply)
$325
$325
 Tooth Extraction, non-surgical
$40
$45
 Teeth Whitening (per arch)
$125
$125
 Periodontal Scaling, limited to four quadrants during any 12 consecutive months
$80
$85
 Child Orthodontics
$2,600
$2,700
 Adult Orthodontics
$2,800
$2,900
 APPLICATIONS
CAA 54
Application
CAA 55
Application

DeltaCare USA

Advantages

DeltaCare USA is our prepaid plan that features set copayments, no annual deductibles and no maximums for covered benefits. Enrollees must select a primary care dentist in the DeltaCare USA network from whom they receive treatment as in a traditional dental HMO.1

Our DeltaCare USA plans promote great dental health for your enrollees and their families with quality dental benefits at an affordable cost. By covering many diagnostic and preventive services at no cost or with very low copayments, we encourage regular preventive dental visits. Enrollees select a DeltaCare USA dentist to provide most covered services1. All of our network dentistsí offices are independently-owned, and must adhere to Delta Dentalís standards of care, quality and service.

Benefits

  • Extensive benefits
  • No deductible or annual dollar maximums
  • No copayments or low copayments for most diagnostic and preventive services
  • Coverage for more than 250 procedures, including additional cleanings, bleaching, and tooth whitening
  • No exclusions for pre-existing conditions or missing teeth
  • Clearly defined out-of-pocket costs
  • Low turnover of network dentists; enrollees can establish a long-term relationship with their dentists
  • Ability to change selected or assigned network dentists via telephone or Internet
  • Easy referrals to a large specialty care network
  • No claim forms to complete
  • Expanded business hours for toll-free customer service
  • Outstanding quality assurance program that includes credentialing, a quality management program and regular office visits.

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Plan CAA 54 Application (better coverage)

Plan CAA 55 Application (lower premium)

DeltaCare USA DHMO Northern California Dentist Database
DeltaCare USA DHMO Southern California Dentist Database
YOU MUST CHOOSE A PRIMARY DENTIST TO PUT ON OUR APPLICATION.

Fill in this form to have your DeltaCare USA Dental DHMO Insurance brochure with pricing & application mailed to you. Or just call us Toll-free at 877-Look4Life (877-566-5454).
DeltaCare USA Dental DHMO Insurance Coverage Requested
Our Ages
(under age 65)
  My Age or DOB       Spouse's Age  
People Covered
People Covered

Customer Information
Full Full Name
E-mail
Street Address
City
County
State
Zip Code
Home Phone
Work Phone

Have you any comments or special instructions?

 

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Barricks Insurance Services
276 N El Camino Real #6, Oceanside, CA 92058
Phone:   (760) 433-0300  |   Fax:   (760) 433-0304
Toll-Free 1-877-Look4Life  (1-877-566-5454)

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