Plans for Retirees
|
High maximum, three periodontal maintenance cleanings, and policy lifetime deductible. |
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. |
|
|---|---|---|---|
|
Monthly Premium |
$64.65ii |
$56.10ii |
$52.35ii |
|
Monthly Premium |
$74.25ii |
$64.50ii |
$60.25ii |
|
Plan Year Maximum |
$2000 |
1st Yr, 2nd Yr, 3rd Yr |
$1000 |
|
|
None |
None |
None |
|
Deductible |
$100 Policy Lifetime |
$50 |
$50 |
|
Office Visit Copay |
None |
None |
None |
|
Preventive Care |
100% |
100% |
100% |
|
Fillings |
80% |
1st Yr, 2nd Yr, 3rd Yr |
50% |
|
Crowns |
50%v |
50%v |
50%v |
|
Root Canal |
50% |
50% |
50% |
|
Implants |
50% |
50% |
50% |
|
Non-Surgical Extractions |
50% |
50% |
50% |
|
Surgical Extractions |
50% |
Not Covered |
Not Covered |
|
Periodontal Maintenance |
50%viii |
1st Yr, 2nd Yr, 3rd Yr |
50% |
|
Orthodontics |
Not Covered |
Not Covered |
Not Covered |
|
Annual Contract |
Yes |
Yes |
Yes |
|
Waiting Period |
May Apply |
None |
May Apply |
Premium PlanHigh maximum, three periodontal maintenance cleanings, and lifetime policy deductible. 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 |
|---|
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.xi xii xiii
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 Ratexiv |
$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.
v. A Pretreatment Estimate is suggested. Clinical requirements must be met, crowns covered at 50% per tooth every seven years.
viii. No waiting period.
xi. 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.
xii. 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.
xiii. 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.
xiv. 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.
