Notice:

Delta Dental of Washington will be closed on July 3rd, in observance of Independence Day. Normal business hours will resume on July 6th.

Delta Dental of Washington Individual and Family Dental Plans

We offer a variety of Individual and Family dental plans for patients both on and off the Washington Health Benefit Exchange (WAHBE).

Our Individual and Family plans are administered by Wyssta Services, Inc.. As our Health Care Benefit Manager, Wyssta Services, Inc. performs certain tasks on Delta Dental of Washington’s behalf, such as enrollment, claims processing, and customer service. For more information regarding the role of a health care benefit manager, click here.

Washington Health Benefit Exchange (WAHBE) Plans

The Washington Health Benefit Exchange (WAHBE) is a provision of the Affordable Care Act and provides a marketplace for dental and health insurance for individuals and families in Washington State. We're proud to partner with WAHBE in providing dental benefit plans for qualifying families and kids. Patients may search for plans and enroll by visiting https://www.deltadentalwa.com/our-plans/wahbe.

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 WAHBE have a federally mandated grace period of 30 days for the premium to be paid by the insured.

Delta Dental of Washington 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 a 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

1. Medical necessity clinical criteria standards

Web page

2. Orthodontic medical necessity form

Downloadable PDF

Plans for Individuals and Families available off WAHBE (Delta Dental Covers Me Plans)ⁱ

We offer plans for patients outside of the Washington Health Benefit Exchange. Coverage is available to all permanent residents in Washington State. Individual plans are designed for anybody who does not have dental coverage through their current employer or would like additional dental coverage for themselves or their family. Patients can learn more about our plans and enroll by visiting https://www.deltadentalwa.com/our-plans/dental/ and clicking “Get Quote”.

	Premium Plan Our highest annual maximum, and three periodontal maintenance cleanings per year	Plus Ortho Plan Orthodontic benefits such as braces and aligners installed by DMD or DDS	Ascent Plan No waiting period and coverage that increases over the first two years you renew	Enhanced Plan 100% coverage on most preventive care services and 50% on most major procedures	Basic Plan 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 Per Person	$2000	$1500	1st Yr, 2nd Yr, 3rd Yr $1000/$1250/$1500	$1000	$1000
Shared Maximum Benefit	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 Cleanings, exams, x-rays, and fluoride	100%	100%	100%	100%	100% cleanings and exams 50% full mouth and panoramic x-rays and fluoride
Fillings	80%	50%	1st Yr, 2nd Yr, 3rd Yr 50%/60%/70%	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 Three per benefit year	50% One every six months	1st Yr, 2nd Yr, 3rd Yr 50%/60%/70%	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 Apply^xi	None	May Apply	May Apply

Coverage percentages displayed in the table above represent the percentage of the allowed amount that is covered by Delta Dental of Washington.

^i. These are benefit highlights only. Monthly premiums shown are examples of monthly rates for subscriber-only in Washington, effective January 2026. Actual rates may vary (higher or lower) based on plan effective date, plan choice, your age, your location, number of people insured, their age, and relationship to you. For full details of plan, benefits, and pricing, please visit DeltaDentalCoversMe.com.

^ii.Individual 12-month contracted rate.

^iv.Excludes back teeth tooth-colored fillings.

^v.A pretreament estimate is suggested. Clinical requirements must be met, crowns covered at 50% per tooth every seven years.

^viii.No waiting period.

^ix.$1500 lifetime maximum with 12-month waiting period.

^xi.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.

2026 Individual and Family Plan Policies

Delta Dental – Optimum Plan

Downloadable PDF

Delta Dental – Premium Plan

Downloadable PDF

Delta Dental – Plus Ortho Plan

Downloadable PDF

Delta Dental – Ascent Plan

Downloadable PDF

Delta Dental – Enhanced Plan

Downloadable PDF

Delta Dental – Clear Plan

Downloadable PDF

Delta Dental – Basic Plan

Downloadable PDF

Free Office Materials

With health care and health insurance top-of-mind, more patients than ever may be asking your office 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 WAHBE.

To order materials for your office, call us at 1-844-759-6020 or visit us online at http://www.reorder.rgcnet.com/

Easel Display

Brochure Example

Front

Back

Contact Information

For questions and more information about Individual and Family Plans, please call Wyssta Services, Inc. at 1-888-899-3734 M-F, 8 a.m. to 5 p.m or refer to the Delta Dental Covers Me provider portal at https://my.deltadentalcoversme.com/provider.

Frequently Asked Questions

I see that some plans state, “waiting period may apply.” What does this mean?

Certain policies have a 12-month Waiting Period that applies to certain covered procedures. This means that Delta Dental of Washington will not pay towards any of these procedures until the patient has been enrolled in this Policy for 12 continuous months. Please see the “Benefits” section of the specific policy document for procedures that are subject to the Waiting Period.

If the patient was covered under a comparable full-coverage dental plan that included Major services, for at least 12 continuous months before enrolling in this Plan, any Waiting Periods will be waived—provided there was no more than a 63-day gap between their previous coverage and this Policy. Dental services obtained through a discount plan do not qualify as comparable coverage and will not count toward satisfying the Waiting Period requirement.

When your patient enrolled, they were asked to provide information about their previous plans to make sure they qualify for a Waiting Period waiver.

Waiting Periods will not be waived for new members added to this Policy without prior qualifying coverage, or if there was more than a 63-day gap between any of their previous Policies and the effective date of this Policy.

Do Individual and Family plans require preauthorization or pretreatment estimates?

Except for Washington Health Benefit Exchange pediatric medically necessary orthodontics, a pretreatment estimate is not required for any service but will provide you and your patient with general coverage information regarding your benefits before treatment begins.

Are coverage percentages based on billed charges or allowed amounts?

Coverage percentages are based on allowed amounts, after any deductibles are paid. For example, if the coverage percentage listed is “80 percent,” Delta Dental of Washington will pay 80 percent of the amount Delta Dental of Washington allows, after any deductibles are paid. In this case, the patient must pay the remaining 20 percent, which is the coinsurance.

How do annual maximums work for the Delta Dental - Ascent Plan increasing benefit?

The annual maximum, also known as a plan year maximum, is the most Delta Dental of Washington will pay for covered care in a year. After a patient meets that amount, they will need to pay for any other dental services themself until their benefits reset.

For the Ascent Plan only, the annual maximum starts at $1000 per person. If a patient remains in the same policy for a second year, the annual maximum increases to $1250 per person. If they renew the policy for a third consecutive year, the annual maximum increases to $1500 per person.

Are there age limits for orthodontic coverage on the Delta Dental – Plus Ortho Plan?

The Plus Ortho plan covers orthodontic care for kids and adults including braces, aligners, or clear aligners installed by a DMD or DDS. This plan additionally covers athletic mouthguards once every three years, for children ages 6 through 18.

How do claims work during the Washington Health Benefit Exchange (WAHBE) premium grace period?

If a patient misses a payment, we will put a hold on paying their claims starting on the first day of the month after their missed payment. Payment for their claims will stay on hold until their account is paid. After 30 days, we may end this policy, and anyone covered under this policy may lose coverage.

Is there a missing tooth clause?

No, Delta Dental of Washington does not have a missing tooth clause.

How often are plans changed or updated regarding benefits?

Plans are reviewed and filed on a yearly basis which may include changes to plan benefits. In special circumstances, plans may be closed to new sales off cycle.

How are the Individual and Family plans created?

Individual and Family plans are created based on customer value and dental market demand to meet a variety of patient needs.

My patient needs help deciding which Individual and Family plan best fits their needs. Do you have tools to help with their decision making?

Yes, we recommend that you refer patients to our Interactive Plan Finder which asks a short series of questions about their dental health and benefit preferences to identify which plan may be right for them. Note that the plan finder only includes recommendations for Individual and Family plans and not Washington Health Benefit Exchange plans.

Are there Individual and Family flyers or resources that can be shared with patients?

Yes, you can find flyers for your office located in the “Free Office Materials” section of this page.

Don't see your question listed above? Check out the Individual and Family Plan FAQ page.

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Notice:

Delta Dental of Washington Individual and Family Dental Plans

We offer a variety of Individual and Family dental plans for patients both on and off the Washington Health Benefit Exchange (WAHBE).