dental plans

If you are enrolled in the Chevron Dental PPO or Dental HMO Plan in 2024*, you're encouraged to take steps to protect your health and receive at least one preventive dental cleaning** between January 1 and December 31, 2024. If you do not participate in this preventive care measure in 2024, you will pay $120 more for your annual Dental PPO or Dental HMO Plan premium in 2025.

• Only you, the employee, are required to receive this cleaning for purposes of the dental surcharge.
• The Dental Surcharge does not apply to the Dental PPO Plan (Expatriates in the U.S.)
• The procedure codes of D4346, D1110, D4910, D4355, D4341 and D4342 are considered eligible preventive dental care; these procedures will satisfy the cleaning requirement to avoid the dental surcharge in 2023. 
• 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 2025; Dental PPO participants do not need to do anything to report completion of your cleaning.

Verification Process
Delta Dental and the HR Service Center will conduct a separate verification process in early 2025 to determine if the dental surcharge applies to you. 

• If it is determined that the dental surcharge does in fact apply to you in 2025, the BenefitConnect website will be updated and you will be mailed a revised confirmation statement by the end of the first quarter of 2025. 
• 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 2025. 
• The dental surcharge will appear as a separate payroll deduction line item on your pay statements.

Preventive Care Coverage
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 2024. 
• 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).
• Learn more about preventive care.

* If you were hired on or after October 1, 2024 the dental surcharge does not apply to your Chevron dental coverage in 2025. The 2025 dental surcharge does not apply to legacy PDC Energy employees; however, you're required to complete the cleaning requirement in 2025 to avoid a dental surcharge in 2026.

** 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 2023*, you're encouraged to take steps to protect your health and receive at least one preventive dental cleaning** between January 1 and December 31, 2023. If you do not participate in this preventive care measure in 2023, you will pay $120 more for your annual Dental PPO or Dental HMO Plan premium in 2024.

• Only you, the employee, are required to receive this cleaning for purposes of the dental surcharge.
• The Dental Surcharge does not apply to the Dental PPO Plan (Expatriates in the U.S.)
• 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 2023. 
• Procedure codes D4341 and D4342, often referred to as deep cleaning, are treatments for periodontal disease. Starting in 2023, these procedures will satisfy the cleaning requirement to avoid the dental surcharge in 2024.
• 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 2024; Dental PPO participants do not need to do anything to report completion of your cleaning.

Verification Process
Delta Dental and the HR Service Center will conduct a separate verification process in early 2024 to determine if the dental surcharge applies to you. 

• If it is determined that the dental surcharge does in fact apply to you in 2024, the BenefitConnect website will be updated and you will be mailed a revised confirmation statement by the end of the first quarter of 2024. 
• 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 2024. 
• The dental surcharge will appear as a separate payroll deduction line item on your pay statements.

Preventive Care Coverage
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 2023. 
• 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).
• Learn more about preventive care.

* If you were hired on or after October 1, 2023 the dental surcharge does not apply to your Chevron dental coverage in 2024. The 2024 dental surcharge does not apply to legacy B6 employees; however, you're required to complete the cleaning requirement in 2024 to avoid a dental surcharge in 2025.

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

If you are a Dental HMO participant, remind your provider to submit Delta's Patient Encounter Form to DeltaCare USA to ensure you get credit for your preventive cleaning to avoid the dental surcharge.

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

1. 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.
2. Once you have the appropriate documentation, you must submit the documentation to Delta Dental at askdelta@delta.org. The deadline to submit a dispute is June 1 of each year.
3. 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.