Monthly Premium Eastern/Western WA |
Plan year maximum |
Shared Maximum Benefit |
---|---|---|
Family Rate (2 adults + 1 or more children)iii $197.60 / $227.10 |
$2000 per person | None |
Deductible |
Office Visit Copay |
Preventive Care Cleanings (3x), exams (3x), bitewing x-rays (2x) and fluoride (1x) |
$100 Policy Lifetime | None | 100% |
Fillings | Crownsii | Root Canal |
80% | 50% | 50% |
Non-Surgical and Surgical Extractions | Periodontal Maintenance (3x) | Orthodontics |
50% | 50% | Not Covered |
Annual Contract | Waiting Periods | |
Yes | May Apply |
This Plan | |||
---|---|---|---|
Premium Plan | Enhanced Plan | Family Plus Plan | |
Monthly Premium Family Rate (2 adults + 1 or more children) |
Eastern WA / Western WA $197.60 / $227.10iii |
Eastern WA / Western WA $157.70 / $181.25iii |
Eastern WA / Western WA $179.80 / $206.65iii |
Plan Year Maximum per person |
$2000 | $1000 | $1500 |
Shared Maximum Benefit | None | None | Shared Maximum Benefit $250 per person up to $1250 |
Deductible | $100 Policy Lifetime |
$50 | $50 |
Office Visit Copay | None | None | None |
Preventive Care Cleanings, exams, x-rays, and fluoride |
100% | 100% | 100% |
Fillings | 80% | 50%iv | 50% |
Crowns | 50%ii | 50%ii | 50%ii |
Root Canal | 50% | 50% | 50% |
Non-Surgical Extractions | 50% Includes surgical and nonsurgical |
50% |
50% Includes surgical and nonsurgical |
Periodontal Maintenance | 50% Three per benefit year |
50% |
50% Three per benefit year |
Orthodontics | Not Covered | Not Covered | 50% $1500 lifetime maximum with 12 month waiting periodv |
Annual Contract | Yes | Yes | Yes |
Waiting Periods | May Apply | May Apply | May Apply |
i Frequency limits per service apply as outlined in the Plan Features per benefit year table
ii Clinical requirements must be met, crowns covered at 50% per tooth every seven years.
iii These are benefit highlights only. Monthly premiums shown are examples of monthly rates for subscriber-only in Washington, effective January 2023. Actual rates may vary (higher or lower) based on plan choice, your age, your location, number of people insured, their age, and relationship to you. For full details of plan, benefits, and pricing, please visit DeltaDentalCoversMe.com.
iv Tooth-colored fillings on back teeth not included.
v Waiting period may be waived if you have had prior ortho coverage.