Health Care Reform information at your fingertips.
Important: The Delta Dental Family – Essential Plus plan will not be offered in 2019. This plan will be replaced by the Delta Dental Individual and Family – Washington Family Plan. Read more about the upcoming changes on the provider blog.
What is an exchange?
A single, online marketplace for individuals to shop for health insurance.
There are two major types of Health Benefit Exchanges:
Public Exchanges: These are controlled by a government entity. Primarily individuals and small businesses with up to 100 employees can purchase insurance on their own through the Public Exchange. They allow individuals with incomes 400 percent of the federal poverty level to receive subsidized health insurance.
Private Exchanges: These are sponsored by a private company, usually a brokerage house, and will offer individual consumers and small employers in the U.S. a new way to purchase health insurance.
Washington Health Benefit Exchange 2018
What are the benefits of the Delta Dental Individual - Washington kids plan?
- Maximum benefit: No annual maximum
- Plan deductible: $85 per child, per year
- Out of pocket maximum: $350 per child, up to $700 for families with 2 or more children, for covered services received from a Delta Dental PPO℠ or Delta Dental Premier® Dentist
What are the benefits of the Delta Dental Family - Essential Plus plan?
- Maximum benefit: $1,000 with no waiting period
- Plan deductible: Adults: $50 Children: $85 per child
- Out of pocket maximum: Adults: None Children: $350 per child, up to $700 for families with 2 or more children, for services received from a Delta Dental PPO℠ or Delta Dental Premier® Dentist
What kind of unique benefits or exclusions do these plans have?
- Stainless Steel Crowns on posterior teeth (primary and permanent) are the covered benefit
- Permanent Anterior Crowns for patients 12 through 18 years of age require pre-authorization
- Orthodontia must be medically necessary, treatment must be performed by a licensed Orthodontist and requires pre-authorization
- Surgical extractions require pre-authorization
- Medically necessary occlusal orthotics require pre-authorization and an approved pre-authorization for medically necessary orthodontics has been received and approved
Claim payment may be delayed for delinquent premium payment
This plan has a federally-mandated grace period of one month for the premium to be paid by the insured. 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. Delta Dental will hold claims until payment is received, if no premium payment is made all pending claims will be denied, the patient will then be responsible for the entire claim. While we anticipate this will affect a small amount of claims, it's important that
you're aware. As the grace period is 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
With health care and health insurance top-of-mind, more patients than ever may be asking you and your colleagues for recommendations on dental coverage. We’re happy to provide you with easel displays and brochures featuring our Individual & Family plans.
To order materials for your office, call us at 1-844-759-6020 or visit us online at http://www.reorder.rgcnet.com/