Dental Care
Eligible students, scholars and dependents are automatically enrolled in the dental plan, provided they are covered under the Student Insurance Plan. If covered, enrollees are eligible to receive care at the UCSF School of Dentistry, which is part of the Delta Dental network.
Dental Plan
| Annual Deductible: | $25 |
| Annual Maximum Benefit: | $1500 |
| *Preventative Services: | 80% network / 70% non-network |
| **Basic Services: | 80% network / 40% non-network |
| Crowns and Cast Restoration Services: | 80% network / 40% non-network |
| Harmful Habit Appliances: | 80% network / 40% non-network / $500 lifetime maximum |
| *Preventative Services includes two routine exams and cleaning per calendar year, bitewing x-rays, full mouth/panoramic x-rays once every 36 months, two fluoride treatments per calendar year and space maintainers for covered children under age 12. | |
| **Basic Services includes amalgam, silicate or composite restorations, simple oral surgery, complex oral surgery, general anesthesia, endodontics (root canal therapy), dental scaling, periodontal prophy (cleaning), and sealants. | |
Policy Numbers & Network
| Billing | Enrollee ID # | Group Policy # | Network |
|
Delta Dental of California |
Download |
271-0001 | Delta Dental 1-800-765-6003 |
To submit a dental claim, download a Delta Dental Claim Form.
Insurance Brochure
Please refer to pages 27 to 29 of the UCSF 2009-2010 Student Insurance Plan brochure for a detailed description of the dental plan.
