How do dental benefits compare?
Before you enroll in one of our dental plans, use the Dental Benefits At-a-Glance Comparison 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 (COC) or contact the plan. All dental plans include a nonduplication of benefits clause, which applies when you have dental coverage under more than one account.
How do DeltaCare and Willamette Dental Group plans work?
DeltaCare and Willamette Dental Group are managed-care plans. You choose and receive care from a primary care dental provider in that plan’s network. Your provider must give you a referral to see a specialist. If you choose one of these plans and seek services from a dentist not in the plan’s network, the plan will not pay your dental claims. Before enrolling, call the plan to make sure your dentist is in the plan’s network. Do not rely solely on information from your dentist’s office.
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). 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.
- DeltaCare's network is DeltaCare SEBB (Group 9601).
- Willamette Dental Group is underwritten by Willamette Dental of Washington, Inc. Its network is Willamette Dental Group, P.C. with dental offices in Washington, Oregon, and Idaho. Willamette Dental Group administers its own dental network (WA733).
How does Uniform Dental Plan (UDP) work?
UDP is a preferred-provider organization (PPO) plan. You can choose any dental provider, and change providers at any time. More than three out of four dentists in Washington State participate with this PPO.
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 dependent, including preventive visits.
UDP's network is Delta Dental PPO (Group 9600).
What providers can I see?
DeltaCare
You may only see providers in the DeltaCare (Group 9601) 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 9601 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 9600) 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.
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.
