Following are highlights of Dental
Plan A.
Please note, the plan features a network of
dentists who offer discounts not available outside the
network. You can choose to use either in-network or out-of-network
dentists, but you'll save money—for you and the Trust—when
you use Washington Dental Service (WDS) member dentists. For
questions about your dental benefits or dental claims or
to find a WDS member dentist near you, call WDS toll-free
at 800-554-1907. WDS also has a website at www.DeltaDentalWA.com where
you can access certain information. |
Calendar Year Maximum Benefit |
$1,800 per eligible |
Orthodontia Benefit for dependent children
under age 19 only |
Plan pays 70% of eligible expenses |
Orthodontia Lifetime Maximum |
$1,800 per eligible |
| Routine oral exams, teeth cleaning,
fluoride treatments for children, routine x-rays, sealants
for children |
Plan pays 100% of WDS' negotiated fees for WDS dentists;
if services are provided by a non-WDS provider, plan pays
100% of WDS' allowed amount. |
| Fillings, extractions, periodontal
treatment, root canal therapy, oral surgery, anesthesia |
Plan pays 90% of WDS' negotiated fees for WDS dentists;
if services are provided by a non-WDS provider, plan pays
90% of WDS' allowed amount.
General anesthesia is covered when medically necessary
for children through age 6 or a physically or developmentally
disabled person when in conjunction with any covered dental
procedure. |
| CLASS 3 —PROSTHETIC
AND MAJOR RESTORATIVE |
