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(IBEW Local 11 and LA NECA only) - Benefit Tabs™
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New Participant Portal
You can enroll for the new Participant Portal experience. Click here for instructions on how to access the new Participant Portal.
Register for New Participant PortalActive Health Plan Benefit Tabs™
This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.
- Eligibility
- Choice of Plans
- Blue Shield
- Kaiser
- UnitedHealthcare
- Dental
- Vision
- Life Insurance
- Cont. Coverage
- Member Assistance Program (MAP)
- Health Reimbursement Arrangement
How the Plan Works
Delta Dental provides a list of DHMO dentists to you when you enroll. You must sign up with one of these dentists and receive all dental services from that provider or dental practice. You can change dentists by phoning Delta at the number shown below. Only procedures listed on the schedule of benefits are covered.
Sample Procedures
| Code | Description | ENROLLEE PAYS |
|---|---|---|
| D0120 | Periodic oral evaluation – established patient | No Cost |
| D0140 | Limited oral evaluation - problem focused | No Cost |
| D0145 | Oral evaluation for a patient under three years of age and counseling with primary caregiver | No Cost |
| D0150 | Comprehensive oral evaluation - new or established patient | No Cost |
| D0160 | Detailed and extensive oral evaluation - problem focused, by report | No Cost |
Annual Maximum
There is no annual maximum benefit.
Orthodontics
Copayments are listed for each phase of orthodontic treatment (limited, interceptive or comprehensive) and cover up to 24 months of active treatment. Beyond 24 months, an additional monthly fee, not to exceed $125.00, may apply.
Additional Information
DeltaCare USA
Customer Service Phone Number: 800-422-4234
Web Site/Provider Lookup: www.deltadentalins.com
Stay Connected
Plan/Group Number: CA10A
Evidence of Coverage