Delta Dental - Family Plus Plan
The First Individual Delta Dental of Washington Plan with Orthodontic Benefits
Not just for families, the Family Plus Plan is built for individuals seeking orthodontic care for themselves or for their household.i This plan offers 100% coverage for most preventive care services and 50% coverage for braces or aligners installed by a licensed dentist. If you have been wanting to improve your smile, this plan is for you!
- Coverage for mouthguards, root canals, fillings, implants, and other major proceduresii
- 100% coverage on most preventive care services (cleanings, exams, x-rays, and fluoride)ii
- 80% coverage on sealants (for biting surfaces of permanent molars only)
- 50% coverage on orthodontics, up to $1500 per person
- 50% coverage on crownsiii, root canals, surgical and non-surgical extractions, and implantsii
| Monthly Premium Eastern/Western WA |
Plan year maximum |
Shared Maximum Benefit |
|---|---|---|
| Individual Starting Rateii $55.40 / $63.65 |
$1500 per person | Additional $250 maximum benefit per person up to $1250 |
| Deductible |
Office Visit Copay |
Preventive Care Cleanings, exams, x-rays, and fluoride |
| $50 | None | 100% |
| Fillings | Crownsiii | Root Canal |
| 50% | 50% | 50% |
| Non-Surgical & Extractions and Implants | Periodontal Maintenance | Orthodontics |
| 50% | 50% | 50% ($1,500 lifetime maximum w/ 12-month waiting period)i |
| Annual Contract | Waiting Periods | |
| Yes | May Applyi |
| This Plan | |||
|---|---|---|---|
| Family Plus Plan | Ascent Plan | Premium Plan | |
| Monthly Premium Individual Starting Rate |
Eastern WA / Western WA $55.40 / $63.65ii |
Eastern WA / Western WA $52.85 / $60.75ii |
Eastern WA / Western WA $60.90 / $69.95ii Starting rate for Individuals ages 26-50 Actual rate may be higher or lower depending on age |
| Plan Year Maximum per person |
$1500 | 1st Year, 2nd Year, 3rd Year $1000/$1250/$1500 |
$2000 |
| Shared Maximum Benefit | $250 per person up to $1250 | None | None |
| Deductible | $50 | $50 | $100 Policy Lifetime |
| Office Visit Copay | None | None | None |
| Preventive Care Cleanings, exams, x-rays, and fluoride |
100% | 100% | 100% |
| Fillings | 50%i | 1st Year, 2nd Year, 3rd Year 50%/60%/70% |
80% |
| Crowns | 50%iii | 50%iii | 50%iii |
| Root Canal | 50% | 50% | 50% |
| Non-Surgical Extractions | 50% Includes surgical and nonsurgical |
50% | 50% Includes surgical and nonsurgical |
| Periodontal Maintenance | 50% Two per benefit year |
1st Year, 2nd Year, 3rd Year 50%/60%/70% |
50% Three per benefit year |
| Orthodontics | 50% $1500 lifetime maximum with 12-month waiting periodi |
Not Covered | Not Covered |
| Annual Contract | Yes | Yes | Yes |
| Waiting Periods | May Applyi | None | May Apply |
i For Orthodontia covered procedures a 12-month waiting period applies. This means that DDWA will not pay towards any of these procedures until the covered members have been enrolled in this policy for 12 continuous months. The waiting period for Orthodontia treatment will be waived for your family if all family members were covered under another insured dental plan with orthodontic coverage for at least 12 continuous months before you enrolled in this plan, but only if there was no more than a 63-day gap between the previous plan and this plan. Documentation is required to waive the 12-month waiting period.
ii These are benefit highlights only. Monthly premiums shown are examples only of our lowest monthly rates for subscriber-only or family, (subscriber, spouse, plus two children) in Washington, effective January 2022. Actual rates vary based on plan choice, your age, your location, number of people insured, their age, and relationship to you. Waiting periods may be waived if you had qualifying dental coverage for 12-continuous months prior to enrolling. For full details of plan, benefits and pricing, please visit DeltaDentalCoversMe.com.
iii A predetermination is suggested. Clinical requirements must be met, crowns covered at 50% per tooth every seven years
