2026 Washington Health Benefit Exchange (WAHBE) Navigator Resources

We offer two Qualified Dental Plans through the Washington Healthplanfinder™: Delta Dental Individual and Family – Washington Family and Delta Dental Individual – Washington Kids.

Important: Claim payment may be delayed for delinquent premium payment

The Washington Health Benefit Exchange does not require subscribers to pay their premium at time of enrollment and all plans offered on WAHBE have a federally mandated grace period of 30 days for the premium to be paid by the insured.

Delta Dental of Washington will hold claims until we receive premium payment. If no premium payment is made, all pending claims will be denied, and the patient will then be fully responsible for any claims.

Our experience shows this has the potential to affect a significant number of claims, so it's important that you're aware. When checking eligibility through our website, the Interactive Voice Response (IVR) system or your practice management system, the patient will show as eligible during this grace period. As the grace period is a federally mandated requirement, any late charge interest normally considered for a delay in processing a clean claim will not be paid.

Important Documents and Resources

Medical necessity clinical criteria standards

1. Medical necessity clinical criteria standards

Web page

Orthodontic medical necessity form

2. Orthodontic medical necessity form

Downloadable PDF

Additional Resources

Frequently Asked Questions

How can consumers find a dentist?
To find a participating dentist, consumers can use our Find a Dentist online tool. We have a catalog of 4,700 in-network providers throughout Washington state. This list also includes over 200,000 in-network dentists throughout the country.
When is the first premium due for new members?
Premiums are due on the date the new member’s plan goes into effect. Here's how it works: We will send members a new member packet with all the information and the payment coupons they need to make their payments. New members will need to contact Wyssta Services, Inc. (our Health Care Benefit Manager) or send in a check with a coupon for payment before their coverage begins.
Is there an automatic payment option for members?
Following the first premium payment, members have two options:
  • They can set up monthly automatic payments scheduled for the 27th of the month via electronic funds transfer (EFT, our preferred method) or credit card.
  • They may also choose to pay by check using the payment coupons we send in their new member kit.
Will members receive a packet in the mail once they’ve made their first payment?
Yes, once the member has made their first payment, they will receive a packet that includes a welcome letter, benefit highlights page (declaration), and a full policy contract.
What is the difference between the two qualified Delta Dental of Washington Plans: Delta Dental Individual and Family – Washington Family Plan and the Delta Dental Individual – Washington Kids Plan?
The Delta Dental Individual and Family – Washington Family Plan is for adults ages 19+ or adults and children. If prospective members choose this plan for family coverage, they don't need to enroll their children for the Washington Kids plan. Kids are already covered!

The Delta Dental Individual – Washington Kids Plan is for children ages 0-18. It does not cover adults and consumers aren’t required to have an adult plan to purchase a plan for their child(ren).
Are Delta Dental of Washington WAHBE plans offered off the Exchange?
No, the plans that Delta Dental of Washington offers on the Washington Health Benefit Exchange are exclusive to WAHBE consumers.
Where do members go to check their claims, billings, Explanation of Benefits (EOBs), and other information about their plan or account?
A member's best resource is their member dashboard. As soon as they are enrolled, members can access the dashboard through My Delta Dental Covers Me. They can see benefits, claims information, explanations of benefits, and payment history, plus a printable copy of their member ID and much more. For members, it's the ultimate guide to their coverage.
Who administers Delta Dental of Washington Health Benefit Exchange Plans?
Delta Dental of Washington Health Benefit Exchange Plans are administered by Wyssta Services, Inc., a Health Care Benefit Manager acting on behalf of Delta Dental of Washington. As our Health Care Benefit Manager, Wyssta Services, Inc. performs certain tasks on Delta Dental of Washington’s behalf, such as enrollment, claims processing, and customer service. For more information regarding the role of a health care benefit manager, please visit our website at www.deltadentalwa.com/tools-and-resources/health-care-benefit-manager.