AAOA Healthcare - Dental Coverage

WDS Dental Group Dental Plans

This is a brief summary of benefits. It is not a certificate of coverage. For full coverage provisions, including a description of limitations and exclusions, please refer to the benefits booklet or contract. Dental coverage is underwritten by Washington Dental Service. Orthodontia coverage is available for groups of 10 or more employees. There is a six month waiting period for Class III Benefits on Plans 1, 2, 3, 6 and 7 for employer groups without prior coverage. There is a six month waiting period for Class III Benefits on Plans 1, 2, 3, 6 and 7 for new employees who enroll after the group's initial effective date.

(w) Deductible Waived on Class I Benefits

(nw) Deductible Not Waived on Class I Benefits

Group Dental BrochureDownload or print pdf version of WDS Dental Plans

Group Dental BrochureDownload or print pdf version of WDS Group dental Plans

Back to WDS DentalGo back to Washington Dental page

BENEFITS	Delta Dental PPO Plan 8 - 544 2-4 Employees	Delta Dental PPO Plan 2 - 505 5+ Employees	Delta Dental PPO Plan 3 - 506 5+ Employees	Delta Dental PPO Plan 7 - 701 5+ Employees	Delta Dental PPO Plan 6 - 599 10+ Employees	Delta Dental PPO Plan 1 - 504 10+ Employees
Annual Deductible	IN NETWORK OUT OF NETWORK	IN NETWORK OUT OF NETWORK	IN NETWORK OUT OF NETWORK	IN NETWORK OUT OF NETWORK	IN NETWORK OUT OF NETWORK	IN NETWORK OUT OF NETWORK
Individual (Waived on Class I Benefits)	$50 (w) $50 (nw)	$50 (w) $50 (nw)	$50 (w)	$50 (w) $50 (nw)	$50 (w) $50 (nw)	$50 (w) $50 (nw)
Family Maximum (Waived on Class I Benefits)	$150 (w) $150 (nw)	$150 (w) $150 (nw)	$150 (w)	$150 (w) $150 (nw)	$150 (w) $150 (nw)	$150 (w) $150 (nw)
Annual Maximum (Per Calendar Year)	$1,250 $1,000	$1,000	$1,500	$1,500	$1,200	$2,000
Class I Diagnostic & Preventive	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK
• Exams • Prophys • Fluoride • X-Rays • Sealants	100% 80%	100% 100%	100% 80%	90% 70%	100% 70%	100% 100%
Class II Restorative	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK
• Restorations • Endodontics • Periodontics • Oral Surgery	80% 70%	80% 80%	80% 70%	80% 60%	80% 60%	80% 80%
Class III Major	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK
• Crowns • Dentures/Partials • Bridges • Implants	50% 50%	50% 50%	50% 40%	50% 50%	50% 50%	50% 50%
TMJ - Coverage TMJ - B Surgical and Nonsurgical	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK	Benefit % IN NETWORK OUT OF NETWORK
• B Surgical and Nonsurgical • Annual maximun • Lifetime maximum	50% $1,000 $5,000 50% $1,000 $5,000	50% $1,000 $5,000 50% $1,000 $5,000	50% $1,000 $5,000 50% $1,000 $5,000	50% $1,000 $5,000 50% $1,000 $5,000	50% $1,000 $5,000 50% $1,000 $5,000	50% $1,000 $5,000 50% $1,000 $5,000
Optional Coverage Orthodontia	10+ Employees Required $1,500 Maximum Per Person	10+ Employees Required $1,500 Maximum Per Person	10+ Employees Required $1,500 Maximum Per Person	10+ Employees Required $1,500 Maximum Per Person	10+ Employees Required $1,500 Maximum Per Person	10+ Employees Required $1,500 Maximum Per Person

Fitness Reimbursement Program

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