Plans for You and Your Family
Individual and Family Dental Plansi
|
High maximum, three periodontal maintenance cleanings, and policy lifetime deductible. |
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. |
Most affordable plan that covers preventive care, fillings, and non-surgical extractions. |
|
|---|---|---|---|---|---|
|
Monthly Premium Eastern WA |
$64.65ii |
$58.80ii |
$56.10ii |
$52.35ii |
$31.45ii |
|
Monthly Premium Western WA |
$74.25ii |
$67.55ii |
$64.50ii |
$60.25ii |
$36.25ii |
|
Plan Year Maximum |
$2000 |
$1500 |
1st Yr, 2nd Yr, 3rd Yr |
$1000 |
$1000 |
|
|
None |
$250 per person up to $1250 |
None |
None |
None |
|
Deductible |
$100 Policy Lifetime |
$50 |
$50 |
$50 |
None |
|
Office Visit Copay |
None |
None |
None |
None |
$15 |
|
Preventive Care |
100% |
100% |
100% |
100% |
100% cleanings and exams |
|
Fillings |
80% |
50% |
1st Yr, 2nd Yr, 3rd Yr |
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 |
50% |
1st Yr, 2nd Yr, 3rd Yr |
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 Applyxi |
None |
May Apply |
May Apply |
Premium PlanHigh maximum, three periodontal maintenance cleanings, and lifetime policy deductible. Monthly Premium |
|---|
Plus Ortho PlanOrthodontic benefits such as braces and aligners installed by DMD or DDS. Monthly Premium |
|---|
Ascent PlanNo waiting period and coverage that increases over the first two years you renew. Monthly Premium |
|---|
Enhanced Plan100% coverage on most preventive care services and 50% on most major procedures. Monthly Premium |
|---|
Basic PlanMost affordable plan that covers preventive care, fillings, and non-surgical extractions. Monthly Premium |
|---|
Not sure which dental plan is right for you? Try our new
Interactive Plan Finder
Plan Finder only for Individual and Family Dental Plans. Does not include DeltaVision® or Affordable Care Health Act Plans.
Individual DeltaVision® Plans
Choose from our standard DeltaVision® Essential Plan 150 or our premium DeltaVision® Brilliance 200 Plan, available to add to your new dental plan at checkout or to your current dental plan at any time.xii, xiii, xiv
For more information about our DeltaVision® Plans or to add vision to your dental plan, please call us at 844-764-5350.
| DeltaVision® Brilliance 200 Plan |
DeltaVision® Essential 150 Plan |
|
|---|---|---|
| Monthly Premium Individual Starting Ratexv |
$15.55 | $12.50 |
| WellVision Exam® Copay benefit frequency every 12 months |
$0 | $10 |
| Prescription Glasses (frames, lenses) Copay benefit frequency every 12-months |
$0 | $10 |
| Retail Frame Allowance included in prescription glasses benefit frequency every 12-months |
$200 | $150 |
| Costco/Walmart Frame Allowance | $110 | $80 |
| Lenses (single vision, lined bifocal and lined trifocal)
included in prescription glasses copay |
Covered | Covered |
| Polycarbonate Lens Enhancements for Children Copay included in prescription glasses copay |
$0 | $0 |
| Contact Lens Exam Copay Maximum fitting and evaluation |
$0 | $40 |
| Elective Contact Lenses Allowance in lieu of glasses |
$200 | $150 |
| Percentage Saved on Purchases over the Plan Allowance for Frames within 12 months of last WellVision® exam |
20% | 20% |
| Out-of-Network Providers |
Not covered | Not covered |
VSP, eyeconic.com, and WellVision Exam are registered trademarks of Vision Service Plan.
i. These are benefit highlights only. Monthly premiums shown are examples of monthly rates for subscriber-only in Washington, effective January 2025. 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.
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. These are benefit highlights only. Monthly premiums shown are examples of monthly rates for subscriber-only in Washington, effective January 2025. 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 pricings, please visit DeltaDentalCoversMe.com.
