Individual and Family Dental Plansi
|
Highest annual maximum and three periodontal maintenance cleanings per benefit year |
Orthodontic benefits such as braces and aligners installed by DMD or DDS |
No waiting period and coverage that increases over the first two years you renew |
100% coverage on most preventive care services and 50% on most major procedures |
Most affordable plan that covers preventive care, fillings, and non-surgical extractions |
|
|---|---|---|---|---|---|
|
Monthly Premium Eastern WA |
$68.15ii |
$63.45ii |
$60.55ii |
$56.50ii |
$33.95ii |
|
Monthly Premium Western WA |
$78.30ii |
$72.90ii |
$69.60ii |
$65.00ii |
$39.10ii |
|
Plan Year Maximum |
$2000 |
$1500 |
1st Yr, 2nd Yr, 3rd Yr |
$1000 |
$1000 |
|
|
None |
$250 per person up to $1250 |
None |
None |
None |
|
Deductible |
$100 |
$50 |
$50 |
$50 |
None |
|
Office Visit Copay |
None |
None |
None |
None |
$15 |
|
Preventive Care |
100% |
100% |
100% |
100% |
100% cleanings and exams |
|
Fillings |
80% |
50% |
1st Yr, 2nd Yr, 3rd Yr |
50% |
50%iv |
|
Crowns |
50%v |
50%v |
50%v |
50%v |
Not Covered |
|
Root Canal |
50% |
50% |
50% |
50% |
Not Covered |
|
Implants |
50% |
50% |
50% |
50% |
Not Covered |
|
Non-Surgical Extractions |
50% |
50% |
50% |
50% |
50% |
|
Surgical Extractions |
50% |
50% |
Not Covered |
Not Covered |
Not Covered |
|
Periodontal Maintenance |
50%viii |
50% |
1st Yr, 2nd Yr, 3rd Yr |
50% |
Not Covered |
|
Orthodontics |
Not Covered |
50%ix |
Not Covered |
Not Covered |
Not Covered |
|
Annual Contract |
Yes |
Yes |
Yes |
Yes |
Yes |
|
Waiting Period |
May Apply |
May Applyxi |
None |
May Apply |
May Apply |
Premium PlanHighest annual maximum and three periodontal maintenance cleanings per benefit year
Monthly Premium |
|---|
Plus Ortho PlanOrthodontic benefits such as braces and aligners installed by DMD or DDS
Monthly Premium |
|---|
Ascent PlanNo waiting period and coverage that increases over the first two years you renew
Monthly Premium |
|---|
Enhanced Plan100% coverage on most preventive care services and 50% on most major procedures
Monthly Premium |
|---|
Basic PlanMost affordable plan that covers preventive care, fillings, and non-surgical extractions
Monthly Premium |
|---|
Coverage percentages displayed in the table above represent the percentage of the allowed amount that is covered by Delta Dental of Washington.