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Child Health Plan
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Headline: 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.*

*Kaiser Permanente is not responsible for the content or policies of external Internet sites.

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.

Your child will automatically be enrolled in DeltaCare USA and assigned a dentist in your area who is accepting new patients. You should receive a DeltaCare USA membership packet in the mail within four weeks of your child’s enrollment in Kaiser Permanente Child Health Plan. To learn more about the Deltacare program, visit deltadentalins.com or call toll-free 1-800-422-4234.

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. You can access a more complete and up-to-date listing of PMI's dental network through DeltaCare.

Highlights of DeltaCare benefits
January 1, 2010, to March 31, 2010

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 are not covered.

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