. The plan covers
the same services provided by both WDS Preferred (PPO) Providers
and Non-Preferred providers, but at different coinsurance rates.
The following chart shows the coverage provided by the dental plan.
There is a one year wait on all "Major care" services for
all new enrolees choosing the dental plan.
|
Washington
Dental Service |
|
Choice of Dentist |
Any licensed provider. However, WDS participating dentists accept
payment at the plan's allowed reimbursement levels, which may
minimize your out-of-pocket costs. |
|
Calendar Year Deductible |
$50 per person
$150 per family maximum |
|
Calendar Year Benefit Maximum |
$1,500 per person |
|
Preventive Care
Routine exams, x-rays, topical fluoride and space maintainers |
WDS Preferred (PPO) Providers:
100% (deductible waived) |
Non-Preferred Providers:
80% of the allowed amount (deductible waived) |
|
Basic Care
Fillings, simple extractions, oral surgery, periodontic, night
guards & endodontics (root canal therapy) |
WDS Preferred (PPO) Providers:
80% after deductible |
Non-Preferred Providers:
70% of the allowed amount after deductible |
|
Major Care
Inlays, onlays, crowns, bridges & dentures
12 month Waiting Period for Major Care |
WDS Preferred (PPO) Providers:
50% after deductible |
Non-Preferred Providers:
40% of the allowed amount after deductible |
