Delta Dental of California—Large 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. Options is also available for larger businesses with 50 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

Delta Dental Options Plans:

To obtain an Evidence of Coverge or Plan Summary for a Delta Dental Options 50–99 plan, please contact your CoPower Group Service Representative.

Enrollment Forms:

• Delta Dental Enrollment/Change 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