Dental

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We offer two great dental plans through Delta Dental of Washington – the PPO Network Plan and the Open Network Plan. Both plans provide the same level of benefits and cover the same services, but you'll pay for more from your paycheck with the Open Network dental plan.

The PPO Network Plan has the lowest cost to you as you only see dentists in the Delta Dental PPO network, which is a very broad nationwide network of dentists. The PPO dentist will file your claims directly with Delta Dental, cutting down the legwork on your end.

The Open Network Plan allows you to see any dentist you want; however, it comes at a higher cost from your paycheck. Additionally, you may have to file your own claims and reimburse your dentist directly. You also may be charged a higher rate for services.

More Details

Again, the two plans are exactly the same when it comes to coverage. Preventive care, such as your cleaning, is covered at 100%. For other services, you'll pay a percentage of the cost, once you meet an annual individual deductible of $50, or a maximum of $150 per family.

What's covered	Percentage Page	Benefit Maximum
Preventive care (cleanings, bitewing X-rays)	100%, no deductible	Two cleanings per year
Basic services (fillings, routine extractions)	80%, after deductible	Costs apply to the annual $2,000 per-person maximum
Major services (crowns, bridges, dentures)	50%, after deductible	Costs apply to the annual $2,000 per-person maximum
Orthodontia (for children and adults)	50%, no deductible	Separate lifetime maximum of $2,000 per person

Click for a PDF summary of dental coverage and how to utilize the benefit.

Review the Dental Benefits Guide for more information on how to make the most of your benefits.

Bi-Weekly Costs

No Domestic Partner

Domestic Partner Enrolled

Bi-Weekly Pre-Tax vs Post-Tax Contributions for Dental Plans (Domestic Partner Enrolled**)

	PPO Network		Open Network

Coverage Election	Pre-Tax	Post-Tax	Pre-Tax	Post-Tax
Employee plus DP	$6.00	$6.00	$17.00	$14.00
Employee plus Children (where only DP children are covered)	$6.00	$8.00	$17.00	$20.00
Employee plus Family (where DP and at least one non-DP child are covered)	$14.00	$6.00	$38.00	$14.00
Employee plus Family (where DP and only DP child(ren) are covered)	$6.00	$14.00	$18.00	$34.00
Employee plus Family (where no DP and only DP child(ren) are covered)	$12.00	$8.00	$32.00	$20.00

**You are responsible for paying both the pre-tax and the post-tax portion of the contribution.

Imputed Income Domestic Partner Enrolled

Bi-Weekly Imputed Income (Domestic Partner Enrolled***)

Coverage Election	PPO Network	Open Network
Employee plus DP	$5.31	$6.36
Employee plus Children (where only DP children are covered)	$7.97	$8.74
Employee plus Family (where DP and at least one non-DP child are covered)	$5.31	$6.36
Employee plus Family (where DP and only DP child(ren) are covered)	$13.28	$15.10
Employee plus Family (where no DP and only DP child(ren) are covered)	$7.97	$8.74

*** This represents the amount that T-Mobile pays for your domestic partner's coverage. Because the IRS doesn't consider them to be a tax dependent, this amount is added to your paycheck as taxable income.

Claim Processing Details

The claims process will vary depending on your plan.

PPO Network Dental Plan: Your dentist will submit claims and receive payment directly from Delta Dental. No additional action is required by you to start the claims process.

Your network dentist files claims directly with Delta Dental.
Your claim will be processed at the agreed-upon Delta Dental rate.
If you are responsible for part of the charges, you will receive a bill from your dentist for that amount, based on the lower Delta Dental agreed-upon rate.

Open Network Dental Plan: You can choose any dentist you'd like, but the benefits of the Delta Dental network may not be available. Additionally, you may need to do additional work to start the claims process:

Your non-Delta Dental dentist may choose not to submit claims to Delta Dental on your behalf, meaning you may need to submit your own claims or pay upfront and submit for reimbursement.
Your non-Delta Dental dentist can decide how much they will charge you for services, which means both you and T-Mobile may pay more for services. This means you may reach the $2,000/year/person benefit limit sooner than you would if you used a PPO Network dentist.

Non-Delta Dental dentists in Washington State: If your dentist charges more than Delta Dental's standard rates your claim will be processed in two parts. Delta Dental will reimburse the provider up to Delta Dental's standard rates. Any amount above that will be processed separately and a check will be sent to you. That means you'll have to pay your dentist that additional amount directly.

Here's an example: Dave goes to a non-Delta Dental dentist for a cleaning. The dentist charges $300, but Delta Dental's standard rate is $100. Delta Dental will pay the dentist $100 and Dave receives a check for $200 that he then pays directly to his dentist.

NOTE: You are unable to change plans mid-year, even if your dentist moves in or out of the Delta Dental PPO network.

Dental & Vision Options

Explore EPO and PPO plans so you can see and smile your best.

Dental Provider Contact

Delta Dental of Washington
Toll Free: (800) 238-3107
Hours: M-F 6 a.m. - 5 p.m. Pacific
deltadentalwa.com
PPO Network Dental Plan: Group #09037
- Search the Delta Dental PPO Network for providers (you must see a PPO dentist)
Open Network Dental Plan: Group #09034
- You may see any dentist

Physical ID cards are not issued by Delta Dental. Members may download a digital dental ID card at DeltaDentalWa.com/MySmile

	PPO Network		Open Network

Coverage Election	Employee	Employer	Employee	Employer
Employee Only	$6.00	$7.31	$17.00	$7.31
Employee plus Spouse	$12.00	$12.62	$31.00	$12.62
Employee plus Children	$14.00	$15.28	$37.00	$15.28
Employee plus Family	$20.00	$20.59	$52.00	$20.59