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GSA Dental Plan benefits are underwritten by Washington Dental Service (WDS).

For best benefits please verify that your dentist is a Delta member before receiving care. Listings of member dentists are available from the WDS upon request. However, you may select any licensed dentist. Tell your dentist you are covered by the WSU/GSA Dental Plan through WDS Group No. 681 and give your social security number.

 

 

Member Dentists

If you select a dentist who is a member of Washington Dental Service, that dentist has agreed to provide treatment for eligible persons covered by Washington Dental Service/Delta Dental programs according to the provisions of his or her member dentist contract. You won’t have to hassle with sending in claim forms. Participating dentists complete claim forms and submit them directly to Washington Dental Service. They receive payment directly from Washington Dental Service. You will not be charged for more than the approved fee or the fee that the member dentist has filed with us. You may, however, be responsible for copayments and for any elective care you choose to receive outside the covered benefits. To find out whether your dentist is a member, ask him or her, check your plan’s Directory of Dentists or go online to the Washington Dental Service Web site at www.deltadentalwa.com and click on the “Find a Dentist” option.

 

 

Nonmember Dentists

If you select a dentist who is not a member of Washington Dental Service, you are responsible for having your dentist complete and sign a claim form. We accept any American Dental Association-approved claim form that your dentist may provide. It is up to you to ensure that the claim is sent to Washington Dental Service. Since Washington Dental Service does not have fees on file for nonmember dentists, the payment for services performed by a nonmember is based upon actual charges or Washington Dental Service’s allowable fees for nonmember Dentists, whichever is less. The payment will be issued in both your name and that of your dentist unless you specifically authorize that payment be made directly to your dentist.

 

Out-of-State Dentists

If you receive treatment from a dentist outside Washington state, you are responsible for having the dentist complete and sign a claim form. It is up to you to pay the dentist’s bill and submit the claim to Washington Dental Service. Payment will be based upon actual charges or Washington Dental Service’s allowable fees for out-of-state Dentists, whichever is less.

You will receive a Notice of Payment showing the amount paid on your claim and the amount that is your responsibility.

You may obtain claim forms online. WDS will not be obligated to pay for treatment performed in the event claim forms are submitted for payment more than 6 months after the date of rendition of such treatment.

 

 

Summary of Dental Benefits

POLICY YEAR DEDUCTIBLE PER PERSON – $50 Waived on Class I
Reimbursement Levels
Class I ................................................................................90%
Class II ................................................................................75%
Policy Year Maximum per Person ..................................$1,000

SEE POLICY BOOKLET FOR CLASS COVERED TREATMENTS, LIMITATIONS, AND EXCLUSIONS.

The payment level for covered dental expenses arising as a direct result of an accidental bodily injury is 100%, up to the unused policy year maximum (deductible is waived). See Policy Booklet for additional details.

 

Dental Claims Questions

For answers about benefits or your claim, please call or write:

Washington Dental Service
P.O. Box 75983, Seattle, WA 98175-0983
Telephone (206) 522-2300
Toll Free 1-800-554-1907
WDS Group No. 681
www.deltadentalwa.com