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Health Fund

Getting The Most From Your Plan

When you enroll in the DHMO, you must select a Primary Care Dentist (PCD), who will take care of your dental care needs. If you need to see a specialist, your PCD will handle the referral for you. Unlike the DPO, the DHMO requires that your treatment be coordinated by your PCD for you to receive benefits.

Here's how it works:

When You See the Following Provider What to Expect
Primary Care Dentist (PCD) or a specialist referred by your PCD
Non-Primary Care Dentist
  • Your care will not be covered, except under certain emergency circumstances (please see the section below entitled "Emergency Care" for more information).

It is important to keep in mind that the DHMO is available only to participants who reside in California and there are a limited number of dentists in some areas. Before you choose this Dental Plan, you should be certain there's a DHMO dentist who is both convenient to you and accepting new patients. If you have a covered dependent that does not live with you, call Delta Dental's Customer Service Department to determine whether a DHMO network is available where your dependent lives.

To learn more about the dentists who participate in the DHMO network, you can:

  • Call Delta Dental's Customer Service Department for a list of participating dentists in your area; or
  • Log on to the DHMO website to search for a provider online.

Network dentists occasionally change, so you will want to make sure the dentist you choose is still in the DHMO network before you make an appointment. For the most up-to-date information, including whether a dentist is accepting new patients, call the dentist directly.

Changing Primary Care Dentist

If you want to change your primary care dentist (PCD), you may notify Delta Dental's Customer Service Department by phone or in writing. You can also change your PCD online by visiting the DHMO website. If you make the change by the 21st of the month, the change will take effect on the first day of the following month. You can change your PCD as often as
you wish.

If your PCD leaves the network, you will be notified and asked to select another PCD. If you do not select a new PCD, one will automatically be assigned to you, based on your ZIP Code. Having your PCD leave the network is not considered a qualified status change. That means that you won't be able to change your dental plan option until the next Open Enrollment period.

Non-Network Dentists

Except in an emergency situation, the DHMO does not pay any benefits if you go to a non-network dentist or if you receive care from a network dentist without the proper referral from your PCD. This is the case even if you have a covered dependent that doesn't live with you and there's no DHMO network where your dependent lives.

Emergency Care

The DHMO provides limited coverage if you or a covered dependent needs emergency dental care from a non-network dentist when at least one of these qualifying circumstances exists:

  • You are outside the DHMO's service area;
  • Your PCD is unavailable;
  • Your PCD cannot see you within 24 hours of making contact with their office; or
  • Your emergency makes it dentally/medically inappropriate for you to travel to your PCD to receive emergency for services.

The DHMO will reimburse up to $100.00 per emergency, per enrollee, for services performed by a non-network dentist. After you receive emergency care, you must contact your PCD to discuss any follow-up treatment.

For instructions on how to be reimbursed for expenses related to emergency care, call Delta Dental's Customer Service Department.