Plans on the Washington Health Benefit Exchange
Delta Dental Individual and Family - Washington Family Plan
Preventive-focused coverage for Adults; Comprehensive, Qualified Dental Plan (QDP) coverage for Children up to age 19.
- Adult Maximum benefit: $1,000 with no waiting period. No annual max for children
- Plan deductible: $50 per adult: $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
- View summary of benefits
Delta Dental Individual - Washington Kids plan
Comprehensive, QDP coverage for Children up to age 19
- 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 services received from a Delta Dental PPO℠ or Delta Dental Premier® Dentist
- View summary of benefits
Unique benefits or exclusions of the Pediatric QDP's have?
- Stainless Steel Crowns on posterior teeth (primary and permanent) are the covered benefit
Pre-authorization is required for certain services:
- Permanent Anterior Crowns for patients 12 through 18 years of age
- Orthodontia must be medically necessary, treatment must be performed by a licensed Orthodontist
- Surgical extractions
- Medically necessary occlusal orthotics require pre-authorization and an approved pre-authorization for medically necessary orthodontics has been received and approved
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 the Exchange have a federally-mandated grace period of one month for the premium to be paid by the insured.
Delta Dental 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 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
Plans for Individuals and Families available off the Exchange
We offer plans for patients outside of the Washington Health Exchange. Coverage is available to all permanent residents in Washington state, who are not enrolled in an employer-based dental plan or any other dental plan.
We offer five plan types:
- Basic Plan
- Clear Plan
- Classic Plan
- Enhanced Plan
- Premium Plan
Each plan has a unique benefits, co-pays and deductible options. You can read more about each plan type in this brochure.
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 Delta Dental Covers Me Individual & Family plans available off-Exchange.
To order materials for your office, call us at 1-844-759-6020 or visit us online at http://www.reorder.rgcnet.com/