|
Kaiser
Permanente Child Health Plan Dental Program
Kaiser Permanente
Child Health Plan is pleased to offer dental coverage to all our
Child Health Plan members at no additional premium. The DeltaCare
program is administered by PMI,
the HMO affiliate of Delta Dental.
The Kaiser Permanente
Child Health Plan DeltaCare program provides our members with quality
dental benefits at an affordable cost. Seeking dental treatment
is easy as there are no claim forms to complete, no deductibles,
and no annual (or lifetime) dollar maximum.
During the Child
Health Plan application process, you have the option of selecting
a dental office for your child using the Contract Dentist Selection
Form found in your DeltaCare brochure. This form is sent in along
with your Child Health Plan application to Kaiser Permanente.
To ensure quality
service, Kaiser Permanente Child Health Plan members will have access
to a large stable network of dentists. Currently, there are more
than 2,000 dentists in PMI's network throughout California. A more
complete and up-to-date listing of PMI's dental network can be accessed
through DeltaCare.
Additional information or questions about the DeltaCare program
may also be obtained by contacting the PMI Customer Service Department
at 1-800-422-4234.
Highlights
of DeltaCare Benefits
January 1, 2007, to December 31, 2007
| DESCRIPTION |
ENROLLEE
PAYS |
| Comprehensive
oral evaluation - new or established patient |
No
Cost |
| Intraoral
radiographs - complete series (including bitewings)
– limited to 1 series every 24 months |
No
Cost |
| Prophylaxis
cleaning - child – 1 per 6-month period |
No
Cost |
| Topical
application of fluoride (prophylaxis not included) -
child – to age 19; 1 per 6-month period |
No
Cost |
| Sealant
- per tooth – limited to permanent molars through
age 15 |
$10 |
| Amalgam
- one surface, primary or permanent |
$2 |
| Extraction,
coronal remnants - deciduous tooth |
$5 |
|
Orthodontics
not covered
Back
to top of page
|
