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HCR information

Health Care Reform information at your fingertips.

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

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