dental PPO planfor expatriates on assignment in the U.S.

During your expatriates assignment in the U.S., you are eligible to participate in the Chevron Dental PPO Plan (Expatriates in the U.S.).

the basics

  • Delta Dental (Delta) is the claims administrator for the Chevron Dental PPO Plan (Expatriates in the U.S.).
  • The Dental PPO Plan helps you pay for diagnostic, preventive, basic, restorative and major dental care up to the plan’s benefit maximums.
  • You were automatically enrolled in this plan when your expatriate assignment in the U.S. started. You are required to be enrolled in Chevron health coverage while on your expatriate assignment in the U.S.
  • Your eligible dependents were not automatically enrolled in this plan when your expatriate assignment in the U.S. started. You must take action to enroll your eligible dependents by the enrollment deadline. You are also required to verify the eligibility of any new dependents you enroll by completing the dependent verification process. See the How To At-a-Glance and section below for more information about enrollment and the dependent verification process.
  • U.S. health plans have special rules about who you can cover in your health plans. You can generally cover your children, your spouse and your domestic partner. See the Who's Eligible to Participate section below for more information about the dependents you are allowed to enroll in the plan while on your expatriate assignment in the U.S.
  • The Dental PPO Plan is a preferred provider organization (PPO) health plan, this means you can see any dentist you choose, network or out-of-network, but using a network provider saves you money. See the How To At-a-Glance information below for additional important details about the Dental PPO network.
  • In the U.S., the plan will reimburse 100 percent of covered charges when you use a provider that is in network. When you use an out-of-network provider in the U.S. or receive services outside the U.S., the plan generally reimburses you 70 percent for covered charges and the remaining cost is your responsibility. See the Benefit Summary in the Plan Documents section below for more information.
  • This coverage is offered at no extra monthly cost - referred to as a monthly premium -  while you are on an expatriate assignment in the U.S. While there is no monthly premium for this coverage, if you receive services from an out-of-network provider, you will be responsible for paying your share of the cost of that service.
  • The Dental PPO Plan includes 100 percent coverage with no copayment, coinsurance or deductible for certain preventive care services, as specified by the Affordable Care Act, when you see a network provider. Routine preventive care service includes cleanings and x-rays (bitewings) for you and your dependents each year. Learn more about preventive care.
  • The Dental Surcharge does not apply to expatriates on assignment in the U.S.

plan documents

The summary plan descriptions (SPD) provides specific details about your benefits, such as eligibility, covered services and participation rules. If there recent updates to the SPD since the last publication date, look for the summary of material modification (SMM) included in the very front of the book.

The documents listed below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD) since the last publication date. Be sure to review the SMM for an understanding of important plan updates.

Review the schedule of benefits to understand basic information about your dental plan, such as benefits, copayments, deductibles, coinsurance and plan contact information.

Chevron is legally required to provide certain notices to plan participants. These notices are posted on this website for your reference.

how to at-a-glance

You have been automatically enrolled in the Dental PPO Plan as part of the expatriate transfer process. However, if you have eligible dependents, they have not been automatically enrolled in these plans. If you want to cover your dependents under your plan, you must make an enrollment election:

Enroll your dependents:

See the Enrollment & Participation, and Who's Eligible to Participate sections below for additional details about when you can enroll and who is eligible to participate.

You are required to verify the eligibility of any new dependents you enroll in your Chevron health plans. You have up to 60 days to obtain and submit requested documentation that verifies your dependent(s) are eligible to participate in Chevron’s health benefits. If you don’t provide acceptable documentation by the deadline, your dependent(s) will be disenrolled from coverage. Learn more about this process.

Important notice for expatriates
The Global Mobility team requires that you enter dependent information into the Mobile Employee Experience portal within Assignment Pro (APro MEE) for purposes of your expatriate assignment. If you enroll your dependents in Chevron U.S. health benefits, you’ll be required to complete a dependent verification process in the BenefitConnect website to verify their eligibility for health coverage. Know that these processes are entirely separate, and you’ll need to complete both of them as instructed.

Your social security number can be used to identify you with Delta Dental, but we all want to avoid sharing that number whenever possible. Your Delta Dental Enrollee ID is a safer choice. It was included in your welcome kit when you initially enrolled, but it's also available from the Delta Dental website (under Eligibility Information), on your digital ID card, or by calling Delta Dental.

You don’t need an ID card for this plan, so one will not be mailed to you. Just tell your dental office that you’re covered by Delta Dental of California and provide your Name, Date of birth, Employer Name, and Enrollee ID number (or social security number). If you have enrolled dependents, tell them to provide your details, not their own.

You have two ways to access your ID card online and, if desired, make another print out for your use.
Option 1: Print one from your computer.

  • Go to the Delta Dental website and register as a new user.
  • Login to Online Services.
  • Click on My ID card and print.

Option 2: Pull it up on your smartphone.

  • First, if you have not already, go to the Delta Dental website and register as a new user.
  • Next download and register for the mobile app.
  • You can access your digital ID card any time and anywhere from the mobile app.

In the U.S., a network is a group of independent dental care providers that have agreed with your dental plan claims administrator to charge contracted fees for services provided to plan members. With the Dental PPO, you can see any dentist you choose, but it is important to use a network provider in the U.S. because it saves you money on dental care services.

Delta Dental offers two different types of networks in the U.S. Both options are considered network providers, so the plan will reimburse 100 percent of covered charges when you use a provider that is in either of the networks listed below. Both networks cover the same services, have the same annual maximums, the same coinsurance or copayment levels. You do not need to submit a claim when you see a network dentist. The difference between the two comes down to the reduced fees the dentists have agreed to provide Dental PPO plan participants.

  • Delta Dental PPO Network You should try to find a dentist in the Delta Dental PPO℠ network whenever possible.
  • Delta Dental Premier Network If you can’t find a Delta Dental PPO℠ network dentist, a Delta Dental Premier® dentist is the next choice.

What happens when I use an out-of-network provider?
If you visit an out-of-network dentist, you may be responsible for paying your dentist the full amount and submitting a claim to Delta Dental after the visit. When you use an out-of-network provider in the U.S., (or receive services outside the U.S.) the plan generally reimburses you 70 percent for covered charges and the remaining cost is your responsibility.

What if I receive services outside the U.S.?
Keep in mind that Delta Dental does not have a network of providers outside the U.S. Try to schedule your appointments to receive care while you’re in the U.S. But, if you need to receive covered services outside the U.S., the out-of-network level of benefits will apply. In this situation, you’ll likely need to pay for services at the time received and file a claim directly with Delta Dental for reimbursement of covered dental services. Note that if you receive treatment outside the U.S., non-English documents may need to be accompanied by a translation when you submit a claim.

If you visit a network dentist, Delta Dental dentists agree to handle all claims and paperwork for you. But, if you visit an out-of-network dentist, you may be responsible for paying your dentist the full amount and submitting a claim to Delta Dental after the visit. 

  • Dental PPO (Delta) claim form
  • Note that if you receive treatment outside the U.S., non-English documents may need to be accompanied by a translation. Contact Delta for further information about this.
  • To ensure timely payment, you should file your claim as soon as you can. Typically, June 30 of the following year is the normal deadline to submit claims for eligible expenses incurred from January 1 through December 31 of the plan year. 
If your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre-treatment estimate. This estimate includes an overview of services covered by your dental plan and how coinsurance, deductibles and dollar maximum limits might affect your share of the cost. While it's not a guarantee of payment, a pre-treatment estimate can help you predict your out-of-pocket costs.

Keep in mind that Delta Dental does not have a network of providers outside the U.S. Try to schedule your appointments to receive care while you’re in the U.S. But, if you need to receive covered services outside the U.S., the out-of-network level of benefits will apply. In this situation, you’ll likely need to pay for services at the time received and file a claim directly with Delta Dental for reimbursement of covered dental services.

  • Dental PPO (Delta) claim form
  • Note that if you receive treatment outside the U.S., non-English documents may need to be accompanied by a translation. Contact Delta for further information about this.

contacts

The HR Service Center manages your enrollment in and eligibility for this benefit plan. For all other questions regarding your coverage, contact the claims administrator. A claims administrator manages the administration of your plan — for example, claims, account balances, ID cards, what's covered and what's not, provider networks, phone numbers, the administrator's website or mobile app, and more. 

dental PPO plan (expatriates in U.S.)

  • Plan Type  Dental plan
  • Eligibility  Expatriates on assignment in the U.S.
  • Enrollment  Enroll on BenefitConnect or call the HR Service Center
  • Claims Administrator  Delta Dental of California
  • Group Number  18368
  • Networks  Delta Dental PPO (greatest savings) and Delta Dental Premier (still save, but not as much as PPO)
  • Phone (Inside U.S.) 1-800-228-0513 
  • Phone (Outside U.S.) 415-972-8300
  • Website  www.deltadentalins.com/chevron
  • Mobile App  Delta Dental App on Google Play or Apple App Store
  • Claim Form  Forms library

This web page provides only certain highlights about changes of benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. Oral statements about plan benefits are not binding on Chevron or the applicable plan. There are no vested rights with respect to Chevron health care plans or any company contributions towards the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-represented employees.