*Nonparticipating dentist are paid at the Premier network coinsurance levels. If nonparticpating charges are more than WDS maximum allowable fees, the employee is responsible for paying the balance.

Washington Dental Service Benefit Highlights:

• Cover up to four periodontal cleanings a year under certain qualifying periodontal circumstance.
• Periodontal maintenance (prophylactic root planning and scaling) covered under class III.
• Endodontic and Surgical Periodontics are covered under class III.
• Fluoride coverage to age 18 and sealant coverage to age 14.
• Deductible waived for class I services.
• No "missing tooth clause" or pre-existing conditions.
• No late entrant penalties.
• TMJ coverage included - $1,000 annual maximum and $5,000 lifetime maximum.
• Occlusal guards excluded.
• Dependents are eligible for benefits through age 25.

Underwriting Guidelines

• A 12 month waiting period for Class III and orthodontia for groups with 5 to 9 enrolled subscribers.

• Coverage is available to employees working a minimum of 20 hours per week or 80 hours per month.

• Employer must contribute at least 50 percent of the employee premium.
• No employer contribution is required toward the dependent premium.

• Employee participation for groups with 5 to 9 enrolled subscribers is 100 percent of all eligible employees or tied to the company's medical plan (groups' decision).
• Dependent participation for groups with 5 to 9 enrolled subscribers must be the same as the employee.
• Employee participation for groups with 10 to 99 enrolled subscribers is 75 percent enrollment of all eligible employees.
• Dependent participation for groups with 10 to 99 enrolled subscribers is 50 percent of all eligible dependents.

• One-year Guarantee-Premium rates may change at renewal date to be no earlier than 12 months.

• Groups must accept certificates of coverage, benefit booklets (when available), and contracts electronically.
• Groups must accept making ACH payments to Washington Dental Service.
• Group employees must enroll in MySmile and receive Explanation of Benefits electronically.
• Groups must submit a signed and completed Group Master Application, a completed Online Enrollment form and a check for the first month's premium and an Automated Clearing House (ACH) form with a voided check. All these formsmust be submitted by the 20th of the month prior to the requested effective date of the plan (this time period is needed for WDS to process the application and issue a user name and password before starting coverage).

Please contact your Sales Executive on groups with 100 or more enrolled subscribers for plan options.