Family Dental
PLANS AND RATES FOR 2021
September 2020
Covered California Family Dental Plans and Rates for 2021 1
Table of Contents
About Covered California Family Dental Plans ..........................2
Standard Benet Designs ............................................3
Pricing Regions ......................................................8
Dental Companies by County .........................................7
Proles of Participating Dental Companies ............................18
Glossary ...........................................................26
About Covered California
TM
Covered California is the state’s marketplace for the federal Patient Protection and Aordable Care Act. Covered California,
in partnership with the California Department of Health Care Services, was charged with creating a new health insurance
marketplace in which individuals and small businesses can get access to aordable health insurance plans. Covered
California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-
scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then
compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses
can purchase competitively priced health insurance plans and oer their employees the ability to choose from an array of
plans and may qualify for federal tax credits.
In addition to helping consumers who are eligible for federal premium assistance, Covered California seeks to improve the
insurance options for all Californians in the individual market. All of the health insurance plans with embedded children’s
dental are available both through Covered California and in the individual market — at the same price. In addition, every
health insurance company that sells an insurance product to individuals must sell one that matches Covered California’s
standard benet designs. This means that all consumers can now make true apple-to-apples comparisons of their health
insurance options.
Covered California is an independent part of the state government whose job is to make the new market work for
California’s consumers. It is overseen by a ve-member board appointed by the governor and the Legislature. For more
information on Covered California, please visit www.CoveredCA.com.
This booklet does not include dental rates for Covered California for Small Business.
© 2019 Covered California
Covered California Family Dental Plans and Rates for 2021 2
About Covered California’s Family Dental Plans
California families now have expanded opportunities for improved dental health through Covered California’s oerings of
family dental plans.
The plans oer comprehensive coverage for both children and adults. Purchase of the plans is optional and comes at
an additional cost. Adults can choose to enroll in family dental plans without enrolling the entire family. In the individual
exchange, the participating dental carriers are:
• Access Dental Plan
• Anthem Blue Cross
• Blue Shield of California
• California Dental Network
• Delta Dental of California
• Dental Health Services
• Guardian
• LIBERTY Dental Plan
There are two dierent product types available, depending on where a family lives. The dental preferred provider
organization (DPPO) product oers a wide variety of provider choice within a network of participating dentists, as well as
coverage for some out-of-network services. The dental health maintenance organization (DHMO) limits coverage to services
provided by a dentist within a network and generally requires a referral to be seen by a specialist.
Covered California family dental plans feature standard copayments, deductibles and coinsurance requirements. The
children’s benet designs have an actuarial value of at least 85 percent. An actuarial value is the overall average percentage
of costs for benets that a dental plan will cover.
These premiums are for “stand-alone” plans, or dental benet products that can be purchased in addition to a health plan.
Dental plans must follow Covered California standard benet designs. Standardizing benets ensures that the selected
plans dene what the consumers get and allows consumers to choose a plan that’s right for them based on quality,
network and value. Key benet features include comprehensive treatment services like root canals and crowns, along with
diagnostic and preventive services that are available at no charge without being subject to deductible.
Covered California Family Dental Plans and Rates for 2021 3
Family Dental Plan Standard Benet Designs – DHMO
The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan’s Policy or
Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services.
ENROLLEE PAYS – DHMO
Coverage category Child Adult
Diagnostic and preventive
(includes X-rays, exams, cleanings and sealants)
$ 0 $ 0
Amalgam lling – one surface $ 25 $ 25
Root canal – molar $ 300 $ 300
Gingivectomy per tooth $ 50 $ 50
Extraction – single tooth, exposed root or erupted $ 65 $ 65
Extraction – complete bony $ 160 $ 160
Crown – porcelain with metal $ 300 $ 300
Medically necessary orthodontia $ 350 not covered
Enrollee costs
Deductible (waived for diagnostic and preventive) $ 0 $ 0
Annual benet limit none none
Individual out-of-pocket maximum $ 350 N/A
Family out-of-pocket maximum
(two or more children)
$ 700 N/A
Oce copay $ 0 $ 0
Waiting period none none
Covered California Family Dental Plans and Rates for 2021 4
Family Dental Plan Standard Benet Designs – DPPO
*
Waived with proof of prior coverage.
ENROLLEE PAYS – DPPO
Coverage category
Child
IN network
Child OUT
of network
Adult
IN network
Adult OUT
of network
Diagnostic and preventive
(includes X-rays, exams, cleanings and sealants)
0% 10% 0% 10%
Amalgam lling – one surface 20% 30% 20% 30%
Root canal – molar 50% 50% 50% 50%
Gingivectomy per quad 50% 50% 50% 50%
Extraction – single tooth, exposed root or erupted 50% 50% 50% 50%
Extraction – complete bony 50% 50% 50% 50%
Crown – porcelain with metal 50% 50% 50% 50%
Medically necessary orthodontia 50% 50%
not
covered
not
covered
Enrollee costs
Deductible (waived for diagnostic and preventive) $ 75 $ 75 $ 50 $ 50
Annual benet limit none $ 1,500
Individual out-of-pocket maximum $ 350 N/A N/A
Family out-of-pocket maximum
(two or more children)
$ 700 N/A N/A
Oce copay $ 0 $ 0 $ 0 $ 0
Waiting period none none
6 months
*
for major
services
6 months
*
for major
services
The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan’s Policy or
Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services.
Covered California Family Dental Plans and Rates for 2021 5
Notes on Family Dental Plan Standard Benet Designs
Children’s dental benet notes (only applicable to the pediatric portion of the family dental plan)
1. In a coinsurance plan, each child has an individual deductible unless the family deductible has been met. Once a child’s individual
deductible or the family deductible is reached, cost-sharing applies until the child’s out-of-pocket maximum is reached.
2. Cost-sharing payments made by each individual child for in-network services accrue to the child’s out-of-pocket maximum. Once the
child’s individual out-of-pocket maximum has been reached, the plan pays all costs for covered services for that child.
3. In a plan with two or more children, cost-sharing payments made by each individual child for in-network services contribute to the
family deductible, if applicable, as well as the family out-of-pocket maximum.
4. Only enrollees in a Covered California Platinum, Gold, Silver or Bronze health insurance plan are eligible to purchase family dental
plans.
5. The member cost share for Medically Necessary Orthodontia services applies to the course of treatment, not individual benet years
within a multi-year course of treatment. This member cost share applies to the course of treatment as long as the member remains
enrolled in the plan.
Adult dental benet notes (only applicable to the family dental plan)
1. Each adult is responsible for an individual deductible.
2. Families that wish to purchase a family dental plan must include at least one adult who has purchased a Platinum, Gold, Silver or
Bronze insurance plan through Covered California.
3. If a child is enrolled in the family dental plan, all children in the family under age 19 must be enrolled in the same family dental plan.
4. Tooth whitening, adult orthodontia and implants are not covered services.
Dental Terms
Amalgam lling – one surface
A mixture of materials used to repair cavities on a single surface of the tooth.
Annual benet limit
The maximum amount a plan will pay in a benet year toward an adult member’s dental care costs.
Extraction
The removal of a tooth.
Root canal
A dental procedure to x a damaged nerve of a tooth by removing the nerve and lling it with suitable material.
Waiting period
The length of time a newly enrolled adult member must wait before the dental plan pays toward major dental services.
Covered California Family Dental Plans and Rates for 2021 6
Pricing Regions and Plan Availability for Family Dental
Inyo
Kern
San Bernardino
Fresno
Riverside
Siskiyou
Tulare
Lassen
Modoc
Shasta
Imperial
Mono
Trinity
San Diego
Tehama
Plumas
Humboldt
Monterey
Butte
Lake
Madera
Kings
Merced
Yolo
Placer
Ventura
Tuolumne
Glenn
El Dorado
Santa Barbara
Colusa
Sierra
Mendocino
San Luis
Obispo
Sonoma
Mariposa
Stanislaus
Napa
Yuba
San Benito
Nevada
Los Angeles
Solano
San
Joaquin
Alpine
Santa
Clara
Orange
Calaveras
Del
Norte
Sutter
Marin
Alameda
Sacra-
mento
Amador
Contra
Costa
San Mateo
Santa Cruz
San Francisco
Pricing Regions and Plan Availability for Family Dental
Covered California Family Dental Plans and Rates for 2021 7
Alameda ......................... 10
Alpine .................................8
Amador .............................8
Butte ..................................8
Calaveras ..........................8
Colusa ................................8
Contra Costa ................ 10
Del Norte ..........................8
El Dorado .........................9
Fresno ............................ 13
Glenn .................................8
Humboldt .........................8
Imperial .......................... 14
Inyo ................................. 14
Kern ................................ 14
Kings ............................... 13
Lake ....................................8
Lassen ...............................8
Los Angeles ................... 15
Madera ........................... 13
Marin .................................8
Mariposa........................ 12
Mendocino .......................8
Merced ........................... 12
Modoc ...............................8
Mono .............................. 14
Monterey ....................... 12
Napa ..................................8
Nevada .............................. 8
Orange ........................... 16
Placer .................................9
Plumas ..............................8
Riverside ........................ 16
Sacramento .....................9
San Benito ..................... 12
San Bernardino ........... 16
San Diego ...................... 17
San Francisco ..................9
San Joaquin ................... 12
San Luis Obispo ........... 13
San Mateo ..................... 11
Santa Barbara .............. 13
Santa Clara .................... 11
Santa Cruz ..................... 12
Shasta ................................8
Sierra .................................8
Siskiyou .............................8
Solano ...............................8
Sonoma ............................8
Stanislaus ...................... 12
Sutter ................................. 8
Tehama .............................8
Trinity ................................. 8
Tulare ............................. 12
Tuolumne .........................8
Ventura .......................... 13
Yolo ....................................9
Yuba ................................... 8
Dental Companies by County
page number(s)county county page number(s)
The following pages list all the dental rates in each county of the state. This also shows your
pricing region which will provide the plan premium rates on pages 8-17.
Covered California Family Dental Plans and Rates for 2021 8
Pricing Region 1
Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity,
Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino,
Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras,
Tuolumne
FAMILY DENTAL RATES
PLAN ADULT CHILD
Anthem
DPPO
$49.15 $28.55
Blue Shield
DPPO
$43.70 $28.80
Delta Dental
*
DHMO
$23.31 $21.19
Delta Dental
*
DPPO
$50.99 $31.99
Guardian*
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$47.18 $38.52
Pricing Region 2
Napa, Sonoma, Solano, Marin
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $15.30
Anthem
DPPO
$54.36 $32.40
Blue Shield*
DHMO
$25.20 $26.20
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
*
DHMO
$7.63 $10.67
Delta Dental
DHMO
$15.89 $16.42
Delta Dental
DPPO
$56.99 $35.99
Dental Health Services
*
DHMO
$11.93 $13.49
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$21.86 $22.24
* Partial Region
Covered California Family Dental Plans and Rates for 2021 9
Pricing Region 3
Sacramento, Placer, El Dorado, Yolo
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $14.40
Anthem
DPPO
$49.53 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$48.80 $32.10
California Dental Network
*
DHMO
$7.63 $10.67
Delta Dental
*
DHMO
$15.89 $16.42
Delta Dental
DPPO
$51.99 $32.99
Dental Health Services
*
DHMO
$11.93 $13.49
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$8.45 $14.52
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $15.30
Anthem
DPPO
$55.30 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$43.70 $28.80
California Dental Network
DHMO
$7.63 $10.67
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$59.99 $37.99
Dental Health Services
DHMO
$11.93 $13.49
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$8.45 $14.52
Pricing Region 4
San Francisco
* Partial Region
Covered California Family Dental Plans and Rates for 2021 10
Pricing Region 5
Contra Costa
Pricing Region 6
Alameda
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $15.30
Anthem
DPPO
$54.75 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
DHMO
$7.63 $10.67
Delta Dental
*
DHMO
$14.83 $15.36
Delta Dental
DPPO
$56.99 $35.99
Dental Health Services
DHMO
$12.36 $14.21
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$21.86 $22.24
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $14.40
Anthem
DPPO
$54.75 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
DHMO
$7.63 $10.67
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$56.99 $35.99
Dental Health Services
DHMO
$11.93 $13.49
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$8.45 $14.52
* Partial Region
Covered California Family Dental Plans and Rates for 2021 11
Pricing Region 7
Santa Clara
Pricing Region 8
San Mateo
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $14.40
Anthem
DPPO
$54.75 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
DHMO
$7.63 $10.67
Delta Dental
*
DHMO
$14.83 $15.36
Delta Dental
DPPO
$57.99 $35.99
Dental Health Services
DHMO
$11.93 $13.49
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$8.45 $14.52
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $15.30
Anthem
DPPO
$54.75 $32.40
Blue Shield
DHMO
$15.80 $16.40
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
DHMO
$7.63 $10.67
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$56.99 $35.99
Dental Health Services
DHMO
$11.93 $13.49
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$21.86 $22.24
* Partial Region
Covered California Family Dental Plans and Rates for 2021 12
Pricing Region 9
Santa Cruz, Monterey, San Benito
Pricing Region 10
San Joaquin, Stanislaus, Merced, Mariposa, Tulare
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
*
DHMO
$15.00 $21.60
Anthem
DPPO
$53.95 $32.40
Blue Shield
DHMO
$14.60 $15.20
Blue Shield
DPPO
$43.70 $28.80
California Dental Network
*
DHMO
$7.63 $10.67
Delta Dental
DHMO
$15.89 $16.42
Delta Dental
DPPO
$55.99 $35.99
Dental Health Services
*
DHMO
$12.37 $13.96
Guardian
DPPO
$61.46 $56.94
LIBERTY Dental
DHMO
$21.86 $22.24
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
*
DHMO
$9.90 $15.30
Anthem
DPPO
$49.16 $30.10
Blue Shield
DHMO
$15.80 $16.40
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
*
DHMO
$7.63 $10.67
Delta Dental
*
DHMO
$15.89 $16.42
Delta Dental
DPPO
$50.99 $31.99
Dental Health Services
DHMO
$11.93 $13.49
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$24.84 $24.37
* Partial Region
Covered California Family Dental Plans and Rates for 2021 13
Pricing Region 11
Fresno, Kings, Madera
Pricing Region 12
San Luis Obispo, Ventura,
Santa Barbara
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
*
DHMO
$9.90 $15.30
Anthem
DPPO
$47.73 $29.05
Blue Shield
DHMO
$15.80 $16.40
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
*
DHMO
$7.63 $10.67
Delta Dental
*
DHMO
$15.89 $16.42
Delta Dental
DPPO
$48.99 $30.99
Dental Health Services
*
DHMO
$11.95 $13.97
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$21.86 $22.24
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
*
DHMO
$9.90 $13.50
Anthem
DPPO
$51.95 $31.50
Blue Shield*
DHMO
$21.50 $22.40
Blue Shield
DPPO
$48.80 $32.10
California Dental Network
*
DHMO
$8.01 $9.02
Delta Dental
DHMO
$15.89 $16.42
Delta Dental
DPPO
$53.99 $33.99
Dental Health Services
*
DHMO
$11.93 $13.49
Guardian
DHMO
$52.58 $49.19
LIBERTY Dental
DHMO
$25.63 $24.43
* Partial Region
Covered California Family Dental Plans and Rates for 2021 14
Pricing Region 13
Mono, Inyo, Imperial
FAMILY DENTAL RATES
PLAN ADULT CHILD
Anthem
DPPO
$48.55 $30.10
Blue Shield
DHMO
$15.80 $16.40
Blue Shield
DPPO
$43.70 $28.80
California Dental Network
*
DHMO
$8.01 $9.02
Delta Dental
*
DHMO
$15.89 $16.42
Delta Dental
*
DPPO
$49.99 $30.99
Guardian*
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$44.87 $37.90
Pricing Region 14
Kern
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem
DPPO
$47.24 $28.55
Blue Shield
DHMO
$15.80 $16.40
Blue Shield
DPPO
$43.70 $28.80
California Dental Network
*
DHMO
$8.01 $9.02
Delta Dental
*
DHMO
$14.83 $15.36
Delta Dental
*
DPPO
$49.99 $30.99
Dental Health Services
*
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
* Partial Region
Covered California Family Dental Plans and Rates for 2021 15
Pricing Region 15
Los Angeles
Pricing Region 16
Los Angeles
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem
DHMO
$12.00 $12.50
Anthem
DPPO
$48.95 $32.40
Blue Shield
DHMO
$13.40 $14.00
Blue Shield
DPPO
$46.10 $30.30
California Dental Network
DHMO
$8.01 $9.02
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$51.99 $32.99
Dental Health Services
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
* Partial Region
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem
DHMO
$12.00 $12.50
Anthem
DPPO
$50.91 $31.50
Blue Shield
DHMO
$13.40 $14.00
Blue Shield
DPPO
$43.70 $28.80
California Dental Network
DHMO
$8.01 $9.02
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$53.99 $33.99
Dental Health Services
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
Covered California Family Dental Plans and Rates for 2021 16
Pricing Region 17
San Bernardino, Riverside
Pricing Region 18
Orange
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem
DHMO
$12.00 $12.50
Anthem
DPPO
$52.50 $32.40
Blue Shield
DHMO
$13.40 $14.00
Blue Shield
DPPO
$48.80 $32.10
California Dental Network
DHMO
$8.01 $9.02
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$54.99 $34.99
Dental Health Services
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
* Partial Region
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem*
DHMO
$12.00 $12.50
Anthem
DPPO
$49.95 $30.10
Blue Shield
DHMO
$13.40 $14.00
Blue Shield
DPPO
$46.10 $30.30
California Dental Network*
DHMO
$8.01 $9.02
Delta Dental
DHMO
$14.83 $15.36
Delta Dental
DPPO
$50.99 $31.99
Dental Health Services
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
Covered California Family Dental Plans and Rates for 2021 17
Pricing Region 19
San Diego
FAMILY DENTAL RATES
PLAN ADULT CHILD
Access Dental
DHMO
$9.90 $13.50
Anthem
DHMO
$12.00 $12.50
Anthem
DPPO
$49.53 $32.40
Blue Shield
DHMO
$13.40 $14.00
Blue Shield
DPPO
$48.80 $32.10
California Dental Network
DHMO
$8.01 $9.02
Delta Dental
*
DHMO
$14.83 $15.36
Delta Dental
DPPO
$51.99 $32.99
Dental Health Services
DHMO
$10.75 $12.60
Guardian
DPPO
$52.58 $49.19
LIBERTY Dental
DHMO
$7.66 $12.49
* Partial Region
Covered California Family Dental Plans and Rates for 2021 18
Participating Dental Companies
Access Dental Plan | dentalexchange.guardiandirect.com
(844) 561-5600 (Monday – Friday, 9 a.m. to 9 p.m., ET). TTY/TDD, call 711
As a wholly owned subsidiary of The Guardian Life Insurance Company of America, Access Dental Plan is part of a
company that’s been a trusted name in insurance for over 155 years. To us, people count. It’s at the heart of every-
thing we do year after year. It’s no wonder over 8 million dental customers* – and growing – put their trust in us to
get the quality care they need.
You’ll have these advantages with Access Dental Plan:
• Large DHMO network of dentists to choose from – That means nding a primary care dentist (PCD) near you
is easy.
΃ You’ll select and see a PCD or dental oce who participates in Access Dental’s network. You’ll be able
to change your PCD even after making your initial selection
΃ Family members can see the same PCD or choose dierent ones.
• Dental expertise that saves you money – Not only will you have access to a great choice of dentists near you,
but your Access Dental Plan will save you money as you receive the care you need. For example, with a DHMO
plan you’ll pay a copayment (xed dollar amount) at the dentist based on the service you receive. Many diagnos-
tic and preventive services often have no copayment.
Helpful plan information available 24/7
Members have easy access to information about their Access Dental Plan on our website: dentalexchange.guardian-
direct.com. You can:
• Find a Dentist
• View and print ID cards
• Review the services covered under your plan
• Get helpful tips and information to support dental health
Taking care of your teeth can be expensive. That’s why the right dental insurance is so important — it not only pays
for preventive care that can keep you and your family healthy, but it also helps pay for more extensive and costly
care, such as llings, crowns and root canals which often result in unexpected expenses.
Welcome to Access Dental Plan!
Network
General dentists: 10,516
Pediatric dentists: 549
Specialists: 5,732
Access Dental Plan is a wholly-owned subsidiary of The Guardian Life Insurance Company of America, New York, NY.
**Based on Guardian and its subsidiaries, Managed DentalGuard, First Commonwealth Insurance, Premier Access and Access Dental Plan
Covered California Family Dental Plans and Rates for 2021 19
Participating Dental Companies
Anthem Blue Cross of California | www.anthem.com/ca (877) 702-3074
Anthem Blue Cross is one of the largest managed health care companies in California based in Thousand Oaks.
Anthem and its aliates serve nearly 1 million Californians in dental programs statewide. Anthem’s commitment
to providing exceptional customer service to our members is unwavering. With more than 46 years of dental ben-
ets administration experience and 800 dental-focused Anthem team members, consumers can be condent that
Anthem can deliver Best in Class dental programs.
Anthem’s got its members covered
With a long history of providing health and dental plans to Californians, Anthem’s strength and stability in the dental
market oers members a wide network of dentists and locations for both Dental HMO (DHMO) and Dental PPO
plans. Anthem’s PPO plan also oers access to credentialed dentists at more than 70 locations in Mexico for enroll-
ees who travel there.
2021 Expansion
Anthem is pleased to announce the Family Dental HMO plan is expanding into two additional regions (18 & 19) in
2021 while continuing to serve in regions 15, 16 and 17. In 2021, the Dental PPO plan will continue to be oered
statewide.
Digital Tools
The Sydney Health app makes it easier for members to navigate their health care experience. Members can nd
what they need, with one-step access to benet information, Member Services, an interactive chat feature and
more. Once registered on the Sydney Health app, members can check benet information and claim details, com-
pare costs for dental services, search for in-network providers within their plan, access and use their digital ID card
and more.
In addition, there is a new way for members to nd the health care information they need, when they need it, in the
way they want it. Introducing The Anthem Skill for Alexa, our new voice-activated option that works through Ama-
zon’s Alexa-ready devices or on a mobile device using the Amazon Alexa app.* The Skill’s basic features come at no
extra cost and members can order their member ID card, conrm their deductibles and annual maximums, as well
as ask for denitions of common dental terminology.
Members can also visit anthem.com/ca, designed with the same focus on easier access and personalization as
Sydney Health. User-friendly digital tools on our website include the Dental Cost Estimator, for common dental
procedure estimates and treatments, and the Dental Health Assessment, to understand their dental care needs and
costs before receiving care. The Ask a Hygienist online tool allows members to email questions to licensed dental
professionals and receive quick, private, and personalized advice at no extra cost.
*The Anthem Skill may not be available to all members.
Innovative programs
Anthem Whole Health Connection ®℠ is our program that links our Anthem plans together – medical and dental.
This helps the doctors in your plan see a more complete picture of your health, including exam ndings, any pre-
scription medications you take and lab tests results. This will help you receive better care and a better experience.
Network
DPPO General Dentists 19,974; Pediatric Dentists 1,227; Specialists 8,220; Total 29,421.
DHMO General Dentists 8,910; Pediatric Dentists 270; Specialists 3,396; Total 12,576.
Covered California Family Dental Plans and Rates for 2021 20
Participating Dental Companies
Blue Shield of California | blueshieldca.com (855) 836-9705
Blue Shield of California is a nonprot health plan dedicated to ensuring that you – and all Californians – have
access to high-quality dental care at an aordable price. As an independent member of the BlueCross BlueShield
Association, Blue Shield of California has been a trusted partner, serving Californians for over 80 years. Blue Shield
is committed to partnering with Covered California and collaborating with providers to improve your access to qual-
ity dental coverage.
Dental care when and where you need it
With one of the largest networks of dental providers in California, Blue Shield helps you nd the dentist you want
and choice you expect – all with simple, convenient, coordinated care from a name you can trust.
Smile, we’ve got your dental plan
Protect your smile with one of our PPO or HMO dental plans, and you’ll enjoy a range of dental benets, including:
• Cleanings and X-rays for $0 when using network providers
• No waiting period for dental checkups, cleanings, llings, X-rays, or basic services
• A wide range of major restorative dental services and procedures, including crowns, endodontics, periodontics,
oral surgery, and prosthetics
Online tools to easily manage your care
You have easy access to information about your Blue Shield dental plan on our website, blueshieldca.com. You can:
• Find a local dentist using our Find a Doctor tool
• View and print member ID cards
• Review your plan coverage
• Check the status of your claim
• Estimate your dental costs for common dental procedures and treatments
• Get helpful tips and information to support dental health
One of the largest dental networks in California
DPPO General dentists: 12,400
DPPO Pediatric dentists: 646
DPPO Specialists: 3,019
DHMO General dentists: 3,509
DHMO Pediatric dentists: 210
DHMO Specialists: 1,072
Blue Shield of California is an independent member of the Blue Shield Association.
Covered California Family Dental Plans and Rates for 2021 21
Participating Dental Companies
California Dental Network | www.caldental.net (855) 425-4164
As a DentaQuest company, California Dental Network shares in the mission to improve the oral health of all. Cali-
fornia Dental Network, based in Southern California, has been serving individuals, families, employers, unions, and
municipalities throughout California since 1998.
Improving members’ dental and oral health
Reducing individuals’ dental care expenses requires a good dental benets experience so members can achieve
improved dental health. California Dental Network helps members achieve these goals by providing a high-quality
network of dentists from which to receive dental care and excellent customer service support to help members get
the care and benets they deserve.
Quality, accessible dentists
A good dental benets experience begins with the dental oce. Each California Dental Network provider is
screened through the industry’s highest credentialing process (NCQA) to ensure that members receive care from
qualied dentists.
• CDN members rate their dentists’ quality 3.52(on a scale of 4).*
• 94 percent of CDN members would recommend their dental oce.*
Customer service that supports members’ needs
California Dental Network is proud that 97 percent of members would recommend their plan to a friend or family
member.* California Dental Network understands that members and their families are counting on California
Dental Network to help them deal with questions about benets, providers, or just plain “What does this mean?”
California Dental Network’s dedicated Covered California phone line will help members with all of these issues in
their language of comfort. And California Dental Network’s online services provide a 24/7 resource to nd answers
to frequently asked questions and send request for help.
Network Access Points
General Dentists: 17,091
Pediatric Dentists: 632
Specialists: 4,982
*CDN Member Satisfaction Surveys 2017-2019
Covered California Family Dental Plans and Rates for 2021 22
Participating Dental Companies
Delta Dental of California | deltadentalins.com DHMO: (888) 282-8528 I
DPPO: (888) 282-8978
Delta Dental of California is a not-for-prot dental benets administrator headquartered in San Francisco. The
largest dental benets carrier in the state, Delta Dental of California and its aliates cover 36.8 million people
across the U.S. Delta Dental is committed to advancing dental health and access through exceptional dental bene-
ts service, technology and professional support. It prides itself on excellent customer service and on listening and
responding to its members’ needs.
A healthy mouth starts here
Skipping preventive care can lead to serious dental problems. Expensive treatments can quickly add up to more
than a full year’s premium and result in lost time at work or school. Delta Dental oers dierent products, so mem-
bers can choose a plan that best meets their needs.
The Delta Dental PPO™ plan allows members to visit any licensed dentist but gives members industry-leading*
access nationwide to network dentists. PPO dentists agree to never balance bill more than their contracted fees,
which helps keep costs low.
The DeltaCare® USA plan (DHMO) requires members to select a participating primary care dentist to visit for treat-
ment. Using the plan is easy, with set copayments, no deductibles or maximums and no claim forms for general
care. If a mem- ber needs a referral to a specialist, the member’s selected primary dentist will assist in coordinating
that care.
Quick and easy online tools 24/7
Delta Dental makes it easy to nd information from either a mobile device or computer. Members who have regis-
tered for an online account on deltadentalins.com can look up eligibility, view or print their ID card, estimate their
out-of-pock- et costs (for PPO enrollees only), opting for paperless claims and more.
Delta Dental’s online dentist directory lets members search for a network dentist, with enhanced search functions
such as Yelp reviews and Google map locations. Members can search for dentists near a specic address, by name
or by spe- cialty.
Network
PPO unique dentists: 18,100 general dentists, 913 pediatric dentists and 3,899 specialists total
DHMO dental oces: 1,853 general dentist oces, 184 pediatric dentist oces and 2,575 specialist dentist oces total
*NetMinder Dental Network Trend Report, March 2019.
Covered California Family Dental Plans and Rates for 2021 23
Participating Dental Companies
Dental Health Services|dentalhealthservices.com/CA/ | (855) 495-0905
You can be a valued Dental Health Services member! Dental Health Services is a premier prepaid dental benet
solutions company, oering aordable, value rich dental plans for thousands of Californians for over 45 years!
Focused on keeping premiums low for you, Dental Health Services’ qualied dental plans oer:
• Low copayments to ensure you can see a dentist with very little cost out of pocket.
• No maximums which allows you to receive all the care recommended by your dentist.
• No pre-existing condition exclusions ensuring all dental work is eligible for coverage.
Dental Health Services’ Quality Assurance program sets high standards for the care our members receive. Our
program focuses on prevention and wellness for every member. Our exclusive network of participating dentists and
specialists must pass a 107-point Quality Assurance screening process before they can accept members.
Dental Health Services’ plans help you meet your oral care needs with
• Innovative Plan Design
• Member Advocacy and Treatment Plan Review
• A Network of Quality Assured Dentists and Specialists
Your Dental Benet Solutions People!
Dental Health Services is an employee-owned Company which specializes in the provision of prepaid dental plans,
an alternative to traditional insurance. Promoting prevention and wellness, Dental Health Services is committed to
aordable, quality-driven healthcare. To obtain more information, please visit dentalhealthservices.com/CA/ or
call 855.495.0905. A great Reason to Smile℠.
Network
General Dentists: 10,922
Pediatric Dentists: 494
Specialists: 2,066
Covered California Family Dental Plans and Rates for 2020 Dental Health Services 3780 Kilroy Airport Way Suite 750 Long Beach, CA 90806
Covered California Family Dental Plans and Rates for 2021 24
Participating Dental Companies
The Guardian Life Insurance Company | dentalexchange.guardiandi-
rect.com |(844) 561-5600 (Monday – Friday, 9 a.m. to 9 p.m., ET).
For TTY/TDD, call 711.
The Guardian Life Insurance Company of America is a trusted name in insurance for over 160 years. To us, people
count. It’s at the heart of everything we do year after year. It’s no wonder over 8 million dental customers* – and
growing – put their trust in us to get the quality care they need.
You’ll have these advantages with a PPO dental plan from Guardian:
• Large network of dentists to choose from – Guardian is one of the largest dental insurance providers in the
nation. That means nding a dentist near you is easy. Family members under your plan are free to see the same
dentist or choose dierent ones. Plus, you don’t need a referral to see a specialist.
• Dental expertise that saves you money – With our long-standing experience, we have expertise working with
dentists to negotiate discounts for our customers. Any care you receive from a dentist who participates in our
network is more aordable. While you have the freedom to visit any licensed dentist, you save more if you visit
a dentist who is part of Guardian’s network of dentists (averaging 35% o standard rates for services).
Helpful plan information available 24/7
Members have easy access to information about their dental plan on our website: dentalexchange.guardiandirect.com.
You can:
• Find a Dentist
• View and print ID cards
• Review the services covered under your plan
• Estimate the cost of a procedure thru our Dental Cost Estimator
• Take an Oral Health Risk Assessment
• Check the status of a claim
Taking care of your teeth can be expensive. That’s why the right dental insurance is so important — it not only pays
for preventive care that can keep you and your family healthy, but it also helps pay for more extensive and costly
care, such as llings, crowns and root canals which often result in unexpected expenses.
Welcome to Guardian!
Network
General dentists: 16,406
Pediatric dentists: 733
Specialists: 2,648
The Guardian Life Insurance Company of America, New York, NY.
*Based on Guardian and its subsidiaries, Managed DentalGuard, First Commonwealth Insurance, and Access Dental Plan
Covered California Family Dental Plans and Rates for 2021 25
Participating Dental Companies
www.libertydentalplan.com/coveredca | (888) 844-3344
LIBERTY Dental Plan of California, Inc. (LIBERTY) has been administering dental benets since 2001.
Founded and headquartered in California, LIBERTY takes pride in oering a network of quality dental
professionals throughout the Golden State. All contracted dentists undergo screening (credentialing),
background checks, and oce evaluations. This relationship enables LIBERTY members to receive the
care they deserve when enrolling in LIBERTY’s plans.
LIBERTY’s mission is to be the industry leader in providing quality, innovative and aordable dental
benets with the utmost attention to member satisfaction. Their commitment is to deliver cost-eective
services while constantly striving to serve the needs of our members and contracted dentists. They cur-
rently serve over 3 million members nationwide and continue to experience growth in membership and
reputation.
LIBERTY oers their members:
• Benets at copays – no claims required.
• Concierge-style “live” customer service — they answer calls in real time.
• Online access to claims, eligibility and benets, inquiries and more.
• Mobile phone app access to electronic ID cards, dentist search, and benet and copay information.
• Electronic ID cards .
• Access to a network of quality dental professionals throughout the Golden State.
• Service from a local company that specializes in delivering a quality dental benet experience.
Network
General dentists: 7,930
Pediatric dentists: 544
Specialists: 3,305
Covered California Family Dental Plans and Rates for 2021 26
Glossary
Actuarial value
A health insurance plan’s actuarial value is the percentage of total average costs for benets that a health insurance plan
covers. These expenses are usually incurred at the point of receiving health care services — when you visit the doctor or
the emergency room, for example. Dental plans come in two actuarial value options: 85 percent, which features higher
premiums but lower average out-of-pocket costs; and a 70 percent value plan with lower premiums and higher average
out-of-pocket costs. An actuarial value is the percentage of total average costs for benets that a dental plan will cover.
Amalgam lling – one surface
A mixture of materials used to repair cavities on a single surface of the tooth.
Annual benet Limit
The maximum amount a plan will pay in a benet year toward an adult member’s dental care costs.
Coinsurance
Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the
allowed amount for the service, is called coinsurance. You pay coinsurance plus any deductible you may owe. For example,
if the health insurance plan’s allowed amount for an oce visit is $100, and you have met your deductible for the year, your
coinsurance payment of 20 percent would be $20. The health insurance plan pays the rest of the allowed amount. The
allowed amount is the amount the doctor or hospital has agreed to accept for the care provided.
Copayment
A xed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The
amount can vary by the type of covered health care service.
Dental preferred provider organization (DPPO)
A type of dental plan product that delivers dental services to members through a network of contracted dental care
providers and includes limited coverage of out-of-network services.
Dental health maintenance organization (DHMO)
A type of dental plan product that delivers dental services by requiring assignment to a primary dental care provider who
is paid a capitated fee for providing all required dental services to the enrollee unless specialty care is needed. DMHOs
require referral to specialty dental providers. These products do not include coverage of services provided by dental care
providers outside the dental plan.
Extraction
The removal of a tooth.
Out-of-pocket maximum
The most you pay during a policy period (a calendar year) before your health insurance plan begins to pay 100 percent
of the cost of covered services. This limit never includes your premium, balance-billed charges or health care your health
insurance plan doesn’t cover. Some health insurance plans don’t count all out-of-network payments toward this limit.
Root canal
A dental procedure to x a damaged nerve of a tooth by removing the nerve and lling it with suitable material.
Waiting period
The length of time a newly-enrolled adult member must wait before the dental plan pays toward major dental services.
CoveredCA.com