Delta Dental of California—Small Group

Delta Dental of California offers Choice, an exclusive plan to CoPower, for groups with 5 to 99 lives. Delta Dental also offers Classic, another portfolio of dental programs for small businesses with 5 to 99 employees.

Plan Details:

Delta Dental Choice Premier Plans:

Plan Name	Evidence of Coverage	Plan Highlights	Plan Highlights (Spanish)
Choice Premier 1,000 w/out Ortho (5-99)			n/a
Choice Premier 1,500 w/out Ortho (5-99)			n/a
Choice Premier 2,000 w/out Ortho (5-99)			n/a
Choice Premier 1,000 w/ Ortho (10-99)			n/a
Choice Premier 1,500 w/ Ortho (10-99)			n/a
Choice Premier 2,000 w/ Ortho (10-99)			n/a

Delta Dental Choice PPO Plans:

Plan Name	Evidence of Coverage	Plan Highlights	Plan Highlights (Spanish)
Choice PPO 1,000 w/out Ortho (5-99)			n/a
Choice PPO 1,500 w/out Ortho (5-99)			n/a
Choice PPO 2,000 w/out Ortho (5-99)			n/a
Choice PPO 1,000 w/ Ortho (10-99)			n/a
Choice PPO 1,500 w/ Ortho (10-99)			n/a
Choice PPO 2,000 w/ Ortho (10-99)			n/a

Delta Dental Classic PPO Plans:

DeltaCare USA Plans:

Plan Name	Plan Summary	Plan Summary (Spanish)
DeltaCare USA Choice Plan 10B
DeltaCare USA Plan 10A
DeltaCare USA Plan 11A
DeltaCare USA Plan 12A
DeltaCare USA Plan 15B

Enrollment Forms:

• Delta Dental Enrollment/Change Form
• Delta Dental Declination/Waiver Form
• Delta Dental Claim Form

Directories:

• Quarterly DeltaCare USA Northern California Directory of Dentists
• Quarterly DeltaCare USA Southern California Directory of Dentists

Brochures:

• How to Find a Dentist and Save Money
• How to Find a Delta Dental PPO Dentist and Save Money
• Getting the Most from your Delta Dental Premier Program
• Getting the Most from your Delta Dental PPO Program
• A Free Estimate of your Dental Costs
• What Enrollees Want to Know About Dental Insurance
• Dual Coverage Brochure
• Contractual Limitations and Exclusions

General Information:

• Delta Dental Grievance Procedure & Claims Appeal

CoPower Manuals:

• Delta Dental Manual
• DeltaCare USA Manual