dental plans

view your coverage

Review your current dental benefit elections, who’s covered, and your costs on the BenefitConnect website.

no dental surcharge in 2021

The COVID-19 pandemic has complicated the routines of life. That’s why if you are unable to complete a dental cleaning in 2020, the $120 dental surcharge will not be applied to you in 2021. Dental hygiene is an important contributor to overall good health, so you’re still encouraged to get your annual dental preventive care when the time is right for you. Note: This change does not affect the current 2020 dental surcharge as the cleaning deadline was December 31, 2019.

dental surcharge

The COVID-19 pandemic has complicated the routines of life, including getting your dental preventive care. That’s why if you are unable to complete a dental cleaning in 2020, the $120 dental surcharge will not be applied to you in 2021. Dental hygiene is an important contributor to overall good health, so you’re still encouraged to get your annual dental preventive care when the time is right for you. This change does not affect the current 2020 dental surcharge as the cleaning deadline was December 31, 2019. 

Please note the surcharge is currently suspended only for 2021. This means that if you are enrolled in the Chevron Dental PPO or Dental HMO Plan in 2021, you'll need to receive at least one preventive dental cleaning* between January 1 and December 31, 2021 to avoid a dental surcharge in 2022.  

* For participants with dentures, receive at least one oral exam in lieu of a cleaning.

If you are enrolled in the Chevron Dental PPO or Dental HMO Plan in 2021*, you're encouraged to take steps to protect your health and receive at least one preventive dental cleaning** between January 1 and December 31, 2021. Only you, the employee, are required to receive this cleaning for purposes of the dental surcharge. If you do not participate in this preventive care measure in 2021, you will pay $120 more for your annual Dental PPO or Dental HMO Plan premium in 2022. It's still your choice to receive a cleaning or not, but if you choose to participate, you'll save money in 2022 and you'll be doing something good for your health.

  • The procedure codes of D4346, D1110, D4910 and D4355 are considered eligible preventive dental care; these procedures will satisfy the cleaning requirement to avoid the dental surcharge in 2022. 
  • Procedure codes D4341 and D4342, often referred to as deep cleaning, are treatments for periodontal disease; these procedures do not satisfy the cleaning requirement to avoid the dental surcharge in 2022.

You typically do not need to do anything to report completion of your cleaning, however Dental HMO participants should ask their provider be sure to submit Delta's Patient Encounter Form to DeltaCare USA to ensure your cleaning can be properly verified in early 2022. 

Delta Dental and the HR Service Center will conduct a separate verification process in early 2022 to determine if the dental surcharge applies to you. If it is determined that the dental surcharge does in fact apply to you in 2022, the BenefitConnect website will be updated and you will be mailed a revised confirmation statement by the end of the first quarter of 2022. If applicable, the $120 dental surcharge will be applied to your Chevron Dental PPO or Dental HMO Plan coverage over 20 pay periods generally beginning in March 2022. The dental surcharge will appear as a separate payroll deduction line item on your pay statements.

We know dental exams — like many other preventive care exams — are not exactly fun. But there’s a reason they are covered by your plan; they are important to good health. Chevron’s dental plans already cover at least two preventive dental cleanings per year; that will continue in 2021. And covered preventive dental services are generally 100 percent paid by your plan, with no annual maximum, deductible or copayment when you use a network provider (a copayment may apply for some dental HMOs).

* If you were hired on or after October 1, 2021 the dental surcharge does not apply to your Chevron dental coverage in 2022. 

** For participants with dentures, receive at least one oral exam in lieu of a cleaning.

If you are enrolled in the Chevron Dental PPO or Dental HMO Plan in 2019*, you're encouraged to take steps to protect your health and receive at least one preventive dental cleaning** between January 1 and December 31, 2019. Only you, the employee, are required to receive this cleaning for purposes of the dental surcharge. If you do not participate in this preventive care measure in 2019, you will pay $120 more for your annual Dental PPO or Dental HMO Plan premium in 2020. It's still your choice to receive a cleaning or not, but if you choose to participate, you'll save money in 2019 and you'll be doing something good for your health.

  • The procedure codes of D4346, D1110, D4910 and D4355 are considered eligible preventive dental care; these procedures will satisfy the cleaning requirement to avoid the dental surcharge in 2020. 
  • Procedure codes D4341 and D4342, often referred to as deep cleaning, are treatments for periodontal disease; these procedures do not satisfy the cleaning requirement to avoid the dental surcharge in 2020.

Delta Dental and the HR Service Center have completed the verification process to determine if the dental surcharge applies to you. If it is determined that the dental surcharge does in fact apply to you in 2020, the BenefitConnect website is now updated and you have been mailed a revised confirmation statement reflecting your surcharge status. If applicable, the $120 dental surcharge is now being applied to your Chevron Dental PPO or Dental HMO Plan coverage for 20 pay periods in 2020. The dental surcharge will appear as a separate payroll deduction line item on your pay statements. If the surcharge is being applied to you and you believe this is an error, see the dispute instructions later in this section.

* If you were hired on or after October 1, 2019 the dental surcharge does not apply to your Chevron dental coverage in 2020. In addition, the dental charge will not apply to former PRSI employees in 2020. 

** For participants with dentures, receive at least one oral exam in lieu of a cleaning.

Update: We are aware that dental offices around the country are closed due to the COVID-19 outbreak and that it may be difficult for you to access the cleaning documentation you need to dispute the 2020 dental surcharge. For this reason, the deadline to dispute the 2020 dental surcharge has been extended to September 1, 2020. We will continue to monitor the situation and make adjustments as needed. 

If you believe the dental surcharge was assessed to you in error, dispute the surcharge assignment as follows:

  • Contact your dentist for documentation related to the preventive treatment. To be considered, the documentation must include
    • Dental provider’s name.
    • Date of service.
    • Your name (the employee) as the patient.
    • An eligible procedure code.
  • Once you have the appropriate documentation, you must submit the documentation to Delta Dental at askdelta@delta.org. You’ll receive an email verifying receipt of your dispute request. Your dispute will be reviewed in approximately 2-3 weeks, and you’ll be informed of the results of the review as follows:
    • If it is determined you have met the preventive care requirement and the dental surcharge does not apply to you, your enrollment record will be automatically updated with the HR Service Center. The HR Service Center will mail a corrected confirmation statement to you and your corrected dental surcharge status will be automatically updated on the BenefitConnect website. Any dental surcharge amounts you may have already paid this year will be processed and refunded to you on a subsequent regularly scheduled paycheck.
    • If it is determined you have not met the preventive care requirement and the dental surcharge applies to you, you will receive a written follow-up directly from Chevron. 

where's my ID card?

You don’t need an ID card for the Dental PPO Plan, so one will not be mailed to you. Get more information about Dental PPO identification

If you enrolled in the Dental HMO Plan for the first time, DeltaCare will mail a letter containing your primary care dentist name, your Enrollee ID, an ID card and a description of your benefits. This package will also provide instructions about how you can change the primary care dentist auto assigned to you. Learn more about Dental HMO identification here.