Compare dental plans

Compare the dental plans and benefits available to PEBB subscribers and dependents.

How do dental benefits compare?

Before you enroll in one of our dental plans, use the tables below to get the details you need to help you decide. For information on specific benefits and exclusions, refer to the dental plan’s certificate of coverage or contact the plan directly.

  Uniform Dental Plan (UDP)* Preferred-provider plan DeltaCare* Managed-care plan Willamette Dental Group Managed-care plan
Benefits You pay after deductible You pay You pay
Dentures 50% PPO and out of state; 60% non-PPO $140 for complete upper or lower $140 for complete upper or lower
Root canals
(endodontics)
20% PPO and out of state; 30% non-PPO $100 to $150 $100 to $150
Nonsurgical TMJ 30% of costs until plan has paid $500 for PPO, out of state, or non-PPO; then any amount over $500 in member's lifetime 30% of costs, then any amount after plan has paid $1,000 per year, then any amount over $5,000 in member's lifetime Any amount over $1,000 per year and $5,000 in member's lifetime
Oral surgery 20% PPO and out of state; 30% non-PPO $10 to $50 to extract erupted teeth $10 to $50 to extract erupted teeth
Orthodontia 50% of costs until plan has paid $1,750 for PPO, out of state, or non-PPO, then any amount over $1,750 in member's lifetime (deductible doesn't apply) Up to $1,500 copay per case Up to $1,500 copay per case
Orthognathic surgery 30% of costs until plan has paid $5,000 for PPO, out of state, or non-PPO; then any amount over $5,000 in member's lifetime 30% of costs until plan has paid $5,000; then any amount over $5,000 in member's lifetime 30% of costs until plan has paid $5,000; then any amount over $5,000 in member's lifetime
Treatment of gum disease
(periodontic services)
20% PPO and out of state; 30% non-PPO $15 to $100 $15 to $100
Preventive/diagnostic
(deductible doesn't apply)
$0 PPO; 10% out of state; 20% non-PPO $0 $0
Restorative crowns 50% PPO and out of state; 60% non-PPO $100 to $175 $100 to $175
Restorative fillings 20% PPO and out of state; 30% non-PPO $10 to $50 $10 to $50

*administered by Delta Dental of Washington.

How do DeltaCare and Willamette Dental Group plans work?

DeltaCare and Willamette Dental Group are managed-care plans. You must select and receive care from a primary care dental provider in that plan’s network. Referrals are required from your primary care dental provider to see a specialist. You may change providers in your plan’s network at any time.

Neither plan has an annual deductible. You don’t need to track how much you have paid out of pocket before the plan begins covering benefits. You pay a set amount (copay) when you receive dental services. Neither plan has an annual maximum that they pay for covered benefits (some specific exceptions apply).

How does Uniform Dental Plan work?

UDP is a preferred-provider organization (PPO) plan. You can choose any dental provider, and change providers at any time. When you see a network provider, your out-of-pocket expenses are generally lower than if you chose a provider who is not part of this network. Under UDP, you pay a percentage of the plan’s allowed amount (coinsurance) for dental services after you have met the annual deductible. UDP pays up to an annual maximum of $1,750 for covered benefits for each enrolled family member, including preventive visits.

What providers can I see?

DeltaCare

You may only see providers in the DeltaCare (Group 3100) network. You'll have a primary care provider who oversees your care, and authorizes specialist referrals. If the provider you select is not in DeltaCare's Group 3100 network, you will be responsible for the costs.

Uniform Dental Plan

You may see any dental provider, but you'll usually pay less out of pocket if you go to a provider in the Delta Dental PPO Group 3000 network.

Willamette Dental Group

You may only see providers in the Willamette Dental Group network. You'll have a primary care provider who oversees your care, and authorizes specialist referrals.

What if I see an out-of-network provider?

DeltaCare

You'll be responsible for the costs.

Uniform Dental Plan

You'll be responsible for having your provider complete and sign a claim form.

Willamette Dental Group

You'll be responsible for the costs.

Preauthorization criteria

Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that your plan will pay for those services, supplies, or drugs.

Delta Dental of Washington  (for DeltaCare and Uniform Dental Plan)

Willamette Dental Group

These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.