The USC Verdugo Hills dental insurance plan is administered by Delta Dental.
BENEFIT | In-network (Delta Dental provider) | Out-of-network |
Deductible Individual / family | $50 / $150 | $50 / $150 |
Maximum | $1500 per person per calendar year (maximum payments to an out-of-network provider: $1000) | $1500 per person per calendar year (maximum payments to an out-of-network provider: $1000) |
Waiting periods | None | None |
Diagnostic and preventive services • Routine oral exams • Cleaning / scaling • Bite-wing and full-mouth X-rays • Space maintainers • Fluoride treatment | 100% (deductible waived) | 80% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists (deductible waived) |
Basic services • Oral surgery • Extractions • Endodontics • Periodontics • Sealants (for children under age 16) • Anesthesia | 80% | 80% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists |
Major services • Crowns • Inlays, onlays, and cast restorations • Bridges and dentures | 50% | 50% of the lesser of the fee actually charged, or the fee that satisfies the majority of Delta Dental dentists |
Implant benefits | 50% | 50% |
Implant maximums | $1,500 Calendar Year | $1,500 Calendar Year |
Orthodontic benefits (adults and children) | 50% | 50% |
Orthodontic lifetime maximum | $1500 per person | $1500 per person |
Delta Dental | www.deltadentalins.com
(800) 765-6003