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.
Delta Dental Individual and Family - Washington Family
For adults ages 19+ or adults plus children.
If you choose this plan for family coverage, you don't need to enroll your children for the Washington Kids plan.
Please refer to chart below for details or view:
Summary of Benefits for this Plan PDF (English) and Benefits Booklet PDF (English)
Delta Dental Individual - Washington Kids
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Choose this plan if you're only covering children ages 0 to 18 and no adults.
Please refer to chart below for details or view:
Summary of Benefits for this Plan PDF (English) and Benefits Booklet PDF (English)
Delta Dental Individual and Family - Washington Kids |
Delta Dental Individual - Washington Kids |
||
|---|---|---|---|
| Adult Coverage | Children's Coverage | Children's Coverage | |
| Description | For adults 19+ years old
|
For children 0-18 years old
|
For children 0-18 years old
|
|
Plan Year Maximum per person |
$1000 | None | None |
| Out-Of-Pocket Annual Maximum | None | $450 for 1 child $900 for 2+ children |
$450 for 1 child $900 for 2+ children |
|
Deductible benefit frequency every 12-months |
$50 | $85 | $85 |
|
Preventive Care Cleanings, exams, x-rays, and fluoride |
100% | 100% | 100% |
| Fillings | 50% | 70% | 70% |
| Crowns | Not Covered | 50% | 50% |
| Root Canals | Not Covered | 70% | 70% |
| Non-Surgical Extractions | Not Covered | 70% | 70% |
| Scaling and Root Planing | Not Covered | 70% | 70% |
| Orthodontics | Not Covered | 50% Medically Necessary Only |
50% Medically Necessary Only |
These are benefit highlights only and not a contract. Benefits shown represent percentages paid by the dental plan, after deductible (if applicable). For full details of plans, benefits, and pricing, please visit WAHealthPlanFinder.org.
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
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”.
Scroll down within the table to view all benefits.
| Plan features | Optimum Plan |
Premium Plan |
Plus Ortho Plan |
Ascent Plan |
Enhanced Plan |
Simple |
Basic Plan |
|---|---|---|---|---|---|---|---|
| Description | NEW for 2027. Cosmetic benefits and highest cost-sharing for restorative and major services |
High maximum and three periodontal maintenance cleanings per benefit year |
Orthodontic benefits such as braces and aligners installed by DMD or DDS |
No waiting period and coverage that increases over the first two years you renew |
100% coverage on most preventive care services and 50% on most major procedures |
NEW for 2027. Fixed out-of-pocket costs and no plan year maximum |
Most affordable plan that covers preventive care, fillings, and non-surgical extractions |
| Shop plans | |||||||
|
$97.30ii |
$74.40ii |
$73.60ii |
$63.60ii |
$55.40ii |
$38.50iii |
$33.85ii |
|
$111.70ii |
$85.50ii |
$84.55ii |
$73.15ii |
$63.75ii |
$50.90iii |
$39.00ii |
|
1st Yr, 2nd Yr, 3rd Yr |
$2000 |
$1500 |
1st Yr, 2nd Yr, 3rd Yr |
$1000 |
None |
$1000 |
None |
None |
$250 per person up to $1250 |
None |
None |
None |
None |
|
$100 |
$100 |
$50 |
$50 |
$50 |
None |
None |
|
None |
None |
None |
None |
None |
None |
$15 |
|
|
100% |
100% |
100% |
100% |
100% |
$85 Copay |
100% cleanings and exams |
80% |
80% |
50% |
1st Yr, 2nd Yr, 3rd Yr |
50% |
$125 Copay |
50%iv |
|
60%v |
50%v |
50%v |
50%v |
50%v |
Not Covered |
||
60% |
50% |
50% |
50% |
50% |
Not Covered |
||
60% |
50% |
50% |
50% |
50% |
Not Covered |
||
60% |
50% |
50% |
50% |
50% |
$125 Copay |
50% |
|
60% |
50% |
50% |
Not Covered |
Not Covered |
$240 Copay |
Not Covered |
|
60%viii |
50%viii |
50% |
1st Yr, 2nd Yr, 3rd Yr |
50% |
Included in Preventive Care Visit |
Not Covered |
|
Not Covered |
Not Covered |
50%ix |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
|
50% teeth whitening or bleaching |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
|
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
|
May Applyx |
May Applyx |
None |
May Applyx |
May Applyx |
May Applyxii |
Optimum Plan |
Premium Plan |
Plus Ortho Plan |
Ascent PlanNo waiting period and coverage that increases over the first two years you renew View all benefits for Ascent Plan
|
Enhanced Plan |
SimpleChoice Plan |
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 2027. 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 (opens in a new tab).
ii. Individual 12-month contracted rate.
iii. Individual 12-month contracted rate for ages 26-50. Actual rate may be higher or lower depending on age.
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 for persons ages 12 years and older. Crowns covered at 60% per tooth every seven years for persons ages 12 years and older under the Delta Dental - Optimum Plan.
vi. A pretreament estimate is suggested. Clinical requirements must be met; 1 crown and 1 implant per person per 12-month policy period.
vii. 2 teeth in 12 months after purchase or renewal, once per tooth every two years after.
viii. No waiting period.
ix. $1500 lifetime maximum with 12-month waiting period.
x. This Policy has a 12-month Waiting Period that applies to certain covered procedures. This means that Delta Dental of Washington will not pay for any of these procedures until you have been enrolled in this Policy for 12 continuous months. If you were 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 your previous coverage and this Policy. To request that the waiting period be waived, you must provide details about your previous coverage.
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.
xii. This Policy has a 6-month Waiting Period that applies to certain covered procedures. This means that Delta Dental of Washington will not pay for any of these procedures until you have been enrolled in this Policy for 6 continuous months. To request that the waiting period be waived, you must provide details about your previous coverage. Contact your previous or current carrier to request a credible coverage letter, which will include all necessary information to determine if your prior coverage satisfies the Waiting Period requirement. You may be asked to provide a copy of this letter to confirm your eligibility. If you were covered under a comparable coverage dental plan for at least 6 continuous months before enrolling in this Plan, any Waiting Periods will be waived—provided there was no more than a 63-day gap between your 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.
2027 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 – SimpleChoice 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?
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?
Are coverage percentages based on billed charges or allowed amounts?
How do annual maximums work for the Delta Dental - Ascent Plan increasing benefit?
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?
How do claims work during the Washington Health Benefit Exchange (WAHBE) premium grace period?
Is there a missing tooth clause?
How often are plans changed or updated regarding benefits?
How are the Individual and Family plans created?
My patient needs help deciding which Individual and Family plan best fits their needs. Do you have tools to help with their decision making?
Are there Individual and Family flyers or resources that can be shared with patients?
Don't see your question listed above? Check out the Individual and Family Plan FAQ page.
