Kaiser Permanente’s Individual and Family dental offerings include adult dental options that are highly complementary to our ACA-compliant embedded child dental plans and designed to work seamlessly with them. These plans are available as additions to our nation-leading health insurance plans and are consistent across Kaiser Permanente’s service area in Maryland, Virginia, and the District of Columbia.

 

All our Individual and Family dental plans share a robust PPO network with no need for referrals for specialist procedures. There are no per visit office visit charges and no waiting periods, so members enjoy comprehensive dental benefits on Day One.

 

In addition, each of KP’s adult dental offerings can be paired with optional enhanced cosmetic dental benefits, including full orthodontic services, implants, and more. If purchased, these orthodontic benefits cover all family members, including children.

 

 

Adult Dental Riders

Kaiser Permanente Smile KPIF Dental EPO

This plan offers the convenience of predictable costs, no deductibles, and no overall limit on annual benefits. Members pay a copay only for services that they receive – there is no charge for preventive care office visits. The plan includes comprehensive coverage of the full range of common dental procedures, including preventive, basic restorative, and major restorative services. Additional coverage for enhanced cosmetic orthodontic procedures can be purchased through the Kaiser Permanente OrthoPlus rider.

 

This plan is the most like the Adult Dental HMO plan offered for 2023 through Dominion Dental.

 

 

Kaiser Permanente Smile KPIF Dental PPO Basic

This plan gives members access to a curated, high-quality collection of in-plan providers, plus the freedom to see any licensed dentist outside of the plan. With in-plan dentists, members receive 80% coverage for preventive care procedures that include the services most frequently performed for adults. If members choose to visit a licensed dentist not included in the network of participating dentists, they receive 60% out -of-network coverage for preventive services.

 

The plan also includes coverage of basic restorative and major restorative services. Additional coverage for enhanced cosmetic orthodontic procedures can be purchased through the Kaiser Permanente OrthoPlus rider. The maximum annual benefit covered is $1,000, both in-plan and out-of-plan, and there is a $50 deductible per person.

 

 

Kaiser Permanente Smile KPIF Dental PPO High

This plan offers a richer alternative to the KP Smile KPIF Dental PPO Basic plan. It gives members access to a curated, high-quality collection of in-plan providers, plus the freedom to see any licensed dentist outside of the plan. With in-plan dentists, members receive 100% coverage for preventive care procedures that include the services most frequently performed for adults. If members choose to visit a licensed dentist not included in the network of participating dentists, they receive 80% out -of-network coverage for preventive services.

 

The plan also includes coverage of basic restorative and major restorative services. Additional coverage for enhanced cosmetic orthodontic procedures can be purchased through the Kaiser Permanente OrthoPlus rider. There is no deductible and the maximum annual benefit covered is $1,500, both in-plan and out-of-plan.

 

 

Pediatric Dental Benefits

 

The plan includes comprehensive coverage for preventive, basic restorative, and major restorative services, with no need for referrals. It also includes a medically necessary orthodontic benefit. This can be enhanced with an optional cosmetic orthodontia rider that provides coverage for braces and other procedures, if purchased with an Adult dental plan.

 

 

Cosmetic Orthodontic Benefits

Medically necessary orthodontic coverage for children under age 19 is included in Kaiser Permanente’s ACA-compliant health plans. This covers conditions such as cleft palate if associated with a medical diagnosis, with a referral from your Primary Care Physician.

 

Enhanced coverage for cosmetic dental procedures including implants, veneers, and orthodontic treatments like braces, is available for purchase through the Kaiser Permanente OrthoPlus rider, at an additional charge. When purchased with an adult dental plan, this rider covers all family members including children under age 19. There is a lifetime benefit limit of $1,000 per individual.