The following are commonly-asked dental benefit questions by employees:
Coverage for Children
Coverage Questions
Delta Dental Plans Association
General Questions
Member Dentist Information
Pre-treatment Estimates
Requests for Information
Coverage for Children
My former spouse and I are divorced. What kind of documentation do I need to provide to Washington Dental Service to maintain the children's dental coverage?
A parenting plan or statement of financial responsibility is required to verify which parent has primary coverage and which has secondary coverage for children in a divorce situation.
I am divorced. If my former spouse and I both have dental coverage, whose insurance covers the children first?
It depends on who has financial health care responsibility and/or custody for the children. If a parent has primary health care responsibility for the children, their coverage will be primary. If parents have joint health care responsibility, the order of benefits is determined by who has custody. If both parents have joint health care responsibility and joint custody, the order of benefits is determined by the parent with the birthday earliest in the calendar year as the primary carrier.
If I am divorced and have physical custody of my children, does my former spouse's dental insurance still cover our children?
If your former spouse has dental coverage that includes dependents, the children have coverage regardless of whether or not they reside with you or your spouse.
Can we have more than two dental insurance policies for our children?
Yes, in some cases, children may be covered by more than two dental insurance policies. They may be covered by one or both parents, as well as one or more step parent. If either parent's insurance policy has a "non-duplication of benefits" provision, the coverage will be subject to contract limitations.
Coverage Questions
How often will my dental plan pay for me to have my teeth cleaned?
How frequently your dental plan will pay for you to have your teeth cleaned depends on the benefits that were purchased by your employer. To find out about your specific coverage, Check Your Coverage.
Do I have to get an “estimate” before having dental treatment done?
If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, called a “predetermination of benefits.” This service is very helpful because it will allow you to know in advance what procedures may be covered, the amount Washington Dental Service may pay toward the treatment and your estimated financial responsibility. Please note that a predetermination is not a guarantee of payment.
My employer group doesn’t provide subscriber ID cards. How will my dentist know I have coverage through Washington Dental Service?
When you go to the dentist, the office staff will verify your eligibility for coverage and determine which dental benefits are available to you. The information you will need to provide the dentist is your personal information, group number, member identification number and insurance carrier name. If you would like an identification card, just sign in at the Washington Dental Service Web site. Your ID card will appear on your MySmile® personal benefits page. You can print out your paper ID card from there. Just click “print.”
Does Washington Dental Service sell dental insurance plans to individuals?
No. Washington Dental Service offers employer-sponsored plans and products only to groups of five or more employees. Please see Patient Direct for more information on other options of coverage.
What does non-duplication of benefits mean?
If you are covered by two dental policies, the non-duplication of benefits provision is a term used to describe how a secondary policy may calculate its portion of payment. The secondary policy pays as much as it would pay if it were primary, minus the primary payment amount. For example, if the primary policy paid 80 percent and the secondary policy would cover 80 percent if it was primary, the secondary policy would not make an additional payment. IF the primary policy paid 50 percent and the secondary policy would cover 80 percent, the secondary policy would pay up to 30 percent.
Will my dental plan provide coverage if I need care when I am out of state?
You may see a dentist while out of state. If they are a Delta Dental member dentist, they will submit the claims for you; however, if you see a non-member dentist you are responsible for having the dentist complete and sign claims forms. You will also need to submit the claims to Washington Dental Service in Seattle. Payment is based on actual charges or Washington Dental Service's maximum allowable fees for participating WDS dentist, which ever is less.
Do I have to see a primary care dentist to get a referral to a specialist?
For most Washington Dental Service plans, you may go to any dentist that is a member of the plan to which you belong. If you have chosen the DeltaCare plan, however, you will need to sign up for a primary care dentist by calling the DeltaCare Customer Service Department at (800) 650-1583.
Delta Dental Plans Association
Will other Delta Dental plans cover my dentist’s fees?
Yes, the other Delta Dentals will honor the approved fees that Washington Dental Service member dentists have on file with us. In turn, Washington Dental Service will honor the fees of member dentists of the other Delta Dental plans.
What is Delta Dental?
Delta Dental Plans Association is a national organization made up of local, nonprofit Delta Dental plans that provide employer groups with dental benefits coverage in all 50 states, the District of Columbia and Puerto Rico. Washington Dental Service is a member of the Delta Dental Plans Association.
General Questions
How do I change my address with Washington Dental Service?
You will need to change your address through your employer.
Can I choose my own dentist?
Yes, you can choose your own dentist, but there are different networks of dentists from which to choose, depending on which Washington Dental Service plan your employer has selected. To maximize the use of your benefits, see “Choosing a Dentist” in the “How to Use Your Program” section of your dental benefits booklet. You can find out whether your dentist is part of your plan’s network in the Find a Dentist section of this Web site. When you sign into the WDS site and click on Find a Dentist, the site will automatically show you only the dentists available in your plan network.
What is my member ID number?
Your member ID number is the unique number that identifies you as a Washington Dental Service subscriber under your dental plan. In some cases, this is your Social Security number; in others, it is a randomly selected identification number that has been assigned to you.
What is the mailing address for Washington Dental Service claims?
If you see a Washington Dental Service member dentist, the dental office will submit your claims for you. If your dentist is not a member dentist, you may send your claims to:
Washington Dental Service
P.O. Box 75983
Seattle, WA 98175
Member Dentist Information
What is the difference between a Delta Dental Premier and Delta Dental PPO dentist?
Delta Dental Premier is our traditional fee-for-service plan. All Washington Dental Service member dentists automatically belong to this network. Delta Dental PPO is our preferred provider plan and has the largest network of PPO dentists in Washington state. PPO network dentists have agreed to provide care based on a lower average fee schedule. You can find out more about WDS’s choice of products and plan designs on this Web site.
What if I’m traveling out of state and need to see a dentist?
Our Find a Dentist online dentist directory is linked to the Delta Dental Plans Association’s National Provider Directory where you can search for dentists outside of Washington state.
How can I obtain a list of Washington Dental Service member dentists?
You can obtain a current Washington Dental Service directory of dentists at Find a Dentist.
What is a Washington Dental Service “member dentist?”
A Washington Dental Service member dentist is a dentist who has signed an agreement with Washington Dental Service stipulating that he or she will provide dental treatment to subscribers covered by Washington Dental Service's group dental care programs. Washington Dental Service member dentists submit claims directly to Washington Dental Service for their patients.
Pre-treatment Estimates
What is a pre-treatment estimate?
A pre-treatment estimate, also known as a “predetermination of benefits,” is a service that Washington Dental Service provides to its enrollees. A predetermination is recommended for more extensive procedures such as crowns, wisdom tooth extractions, bridges, periodontal surgery, dental implants and dentures or if out of pocket expense is a concern. When your dentist predetermines treatment with Washington Dental Service, you’ll receive an estimate of your share of the cost and how much WDS may pay before treatment begins.
How does it work?
To predetermine treatment, your dentist sends Washington Dental Service a proposed treatment plan, along with relevant X-rays. WDS then checks to be sure which services are covered under your plan. Some dental work may be limited or excluded by your policy, and you will want to know what services may be covered before you proceed with treatment. We also calculate how any co-payments and dollar maximum limits might affect your share of the cost. You and your dentist then receive an estimate of the amount Washington Dental Service may pay for approved services and the amount you may be responsible for. Please note that a predetermination is not a guarantee of payment.
Requests for Information
How can I get approved claim forms?
You can quickly download a claim form or you can obtain American Dental Association-approved claim forms from your dentist.
What if I have questions about my dental benefits plan?
If you have questions about your specific dental plan coverage, click on the Check Your Coverage link in the navigation bar at the top of the MySmile home page. For clarification about your explanation of benefits form, click on Your Dental Activity in the top navigation bar. If you still have questions, call Washington Dental Service’s Customer Service Department at (800) 554-1907 or e-mail cservice@deltadentalwa.com.