Plans for You and Your Family

^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.

^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. Eligibility: Vision benefits are only offered in conjunction with Delta Dental of Washington individual dental plans sold through Delta Dental Covers Me. All other eligibility requirements are shared with the dental plan.

^xiii. Administration: We make it easy to pair dental and vision benefits. Application, enrollment and billing processes are coordinated for your convenience through Delta Dental Covers Me.

^xiv. Enrollment: You may enroll in vision benefits up to 2 months prior to the requested effective date. After your application is approved, your coverage starts the first day of the month and continues for 12 months.

^xv. 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.