Learn about vision and dental coverage
Covered eye care
All our medical plans cover adult vision
exams at a copay, coinsurance, or deductible
payment depending on your plan. Glasses
and contact lenses for adults aren’t covered.
But for members 18 and younger, vision
exams and glasses or contact lenses are
covered at no cost.* Visit kp.org/wa/
eyecare
for Kaiser Permanente Eye Care
locations in Washington. Or check our
directory for contracted network providers
at kp.org/wa/directory.
Adding dental coverage
Oral health is an important part of your
overall well-being. When you choose an
off-exchange Kaiser Permanente medical
plan, you can also add dental coverage — for
yourself, your children, or your entire family.
Visit a participating Delta Dental
network dentist
To get the most from your benefits, we
encourage you to see a participating dentist.
These dentists contract with Delta Dental to
provide services at discounted fees and file
all claims for you. Dentists who are part of
Delta Dental's networks will not charge more
than their approved fees and usually cost you
less than out-of-network dentists.
You may choose any licensed dentist to
provide services under this plan. However,
if you go to an out-of-network dentist, Delta
Dental has no control over their fees. You
will be responsible for submitting claims and
paying any difference in the charges. This is
called balance billing.
Finding a Delta Dental
network dentist
Visit deltadentalwa.com and use the Find a
Dentist tool. Remember to choose the Delta
Dental PPO Plus Premier
™
network.
The online directory is easy to use anytime,
at home or on your smartphone. You can
search based on preferences that matter
to you, including dentist name, specialty,
location, and language. You can even see
endorsements from other Delta Dental
patients for categories including extended
office hours, friendly staff, kid-friendly, and
if they help ease anxiety.
For more information or to find
a participating provider, visit
deltadentalwa.com or call Delta Dental
of Washington at 1-800-554-1907.
Choosing your plan
You can choose from 2 kinds of dental plans.
Adult/Family Basic plan
The optional Adult/Family Basic plan
includes dental coverage for everyone
covered on the medical plan.
•
This dental plan is available for adults
or families who buy their medical plan
directly from Kaiser Permanente.
•
Adults or families who purchase their
medical coverage through Washington
Healthplanfinder may also purchase a
dental plan on the Exchange.
Pediatric plan
•
The Pediatric plan offers dental coverage
for those 18 and younger. The state of
Washington requires you to have pediatric
dental coverage as part of your medical plan.
•
This dental plan is available if you buy your
medical plan directly from Kaiser Permanente.
•
If you sign up for a pediatric dental plan
with another company, complete an
Attestation of Pediatric Dental Coverage
form and send it to us along with proof of
dental coverage within 60 days of the start
date of your medical plan.
•
If you do not submit this information
within the 60 days, you won’t meet the
minimum health and dental coverage
that is required by Washington state and
federal regulations.
All dental plans offered and underwritten by Delta Dental of Washington.
*Vision hardware must be prescribed and purchased at a Kaiser Permanente Eye Care location or participating network provider.
1184799238 KPWA 2024
Summary of dental benefits
Adult/Family Basic plan
Pediatric plan
Amount of Maximum Allowable Fee Kaiser Permanente Member pays
Pediatric
(18 and younger)
Adult
(19 and older)
Only for those 18 and younger
Delta Dental
participating
dentist
2
Non-
participating
dentist
Delta Dental
participating
dentist
2
Non-
participating
dentist
Delta Dental
participating
dentist
2
Non-
participating
dentist
Maximum Benefit No Annual Maximum
$1,250 Annual Plan Maximum
$1,000 Annual TMJ
1
Maximum
$5,000 Lifetime TMJ
1
Maximum
No Annual Maximum
Annual deductible
Deductible is waived for
diagnostic, preventive,
and medically necessary
orthodontia
$85 per child per year $50 per adult per year $85 per child per year
Out-of-pocket maximum
$350 per
child per year
$700 per year
for families
with 2 or
more children
Not
applicable
Not applicable
$350 per
child per year
$700 per year
for families
with 2 or
more children
Not
applicable
Diagnostic and
preventive
Deductible is waived
for exams, prophylaxis,
fluoride, X-rays, sealants
0% 0% 0% 0% 0% 0%
Restorative
Restorations (includes
posterior composites),
endodontics,
periodontics,
oral surgery
30% 30% 50% 50% 30% 30%
Major
Crowns, dentures,
partials, and bridges.
Implants and TMJ
1
are
for adults 19 and older
50% 50% 50% 50% 50% 50%
Orthodontia
3
Coinsurance
Lifetime
maximum
Medically necessary
50%
Unlimited
Not covered
Medically necessary
50%
Unlimited
Pediatric Benefits: Only fees paid to a Delta Dental PPO Plus Premier
™
dentist accrue to the annual out-of-pocket maximum.
Rates Adult/Family Basic plan Pediatric plan
Individual only $50.66 This plan bills only for the first three children 18 and younger
Individual + spouse $101.34 1 Individual (<19) $52.88
Individual + child(ren) $112.68 2 Individuals (<19) $105.76
Individual + family $179.18 3 Individuals (<19) $158.64
1
TMJ = temporomandibular joint
2
Includes dental providers in the Delta Dental PPO Plus Premier
™
network
3
Requires preauthorization
This is a brief summary of benefits and is not a contract. For complete plan information, please refer to your Delta
Dental of Washington benefits booklet. Kaiser Permanente refers to Kaiser Foundation Health Plan of Washington.
All dental plans offered and underwritten by Delta Dental of Washington.
1184799238 KPWA 2024
