With multiple adult and child dental options, Kaiser Permanente Smile offers flexible, affordable plans and benefits for both small employers (2 to 50 employees) and mid-size/large employers (51 or more employees).
Plans with the same benefits carry different names in Maryland and Virginia.
The Kaiser Permanente Smile Kids program provides dental benefits that comply with the Essential Health Benefits provisions of the Affordable Care Act (ACA) for children aged 18 and younger. The program includes two plans:
This plan is included with Kaiser Permanente’s Flexible Choice and Added Choice POS medical plans, which offer comprehensive out-of-network coverage.
This plan is included with all other Kaiser Permanente medical plans.
In the District of Columbia, Kaiser Permanente will offer 3 medical plans with included adult dental benefits – one in each in the Gold, Silver, and Bronze tiers – starting in January 2025. These benefits are similar to those offered in the optional EPO / Copay plan in Maryland and Virginia.
In Maryland and Virginia, employers can enhance the Kaiser Permanente medical coverage they offer with one of the following dental options, available for purchase as riders. All the dental plans offer comprehensive coverage for the full range of common dental procedures, including preventive, basic restorative, and major restorative services. Additional coverage for cosmetic dental procedures, such as orthodontic treatments, implants, and veneers, can be purchased through the Kaiser Permanente OrthoPlus rider.
Our EPO plans combine generous or unlimited annual benefit maximums with robust in-network benefits. The PPO plans offer the freedom to visit licensed providers outside the network of participating dentists, while remaining affordable. The POS plans balance unlimited benefits when using in-plan dentists, with access to out-of-network coverage.
This plan offers the convenience of predictable costs, no deductibles, and no annual benefit maximums. Members pay a copay only for services that they receive — there is no charge for preventive care office visits. This is the dental plan most similar to the legacy Adult Dental HMO plan.
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. 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 maximum annual benefit is $1,000, both in-plan and out-of-plan, and there is a $50 deductible per person.
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 100% coverage for preventive care procedures. 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 maximum annual benefit covered is $1,500, both in-plan and out-of-plan, and there is a $25 deductible per person. This is the dental plan most similar to the legacy PPO 1/POS 1 plan.
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 100% coverage for preventive care procedures. 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 maximum annual benefit is $2,000, both in-plan and out-of-plan, and there is a $25 deductible per person. This is the dental plan most similar to the legacy PPO 3/POS 3 plan.
This plan combines the convenience of predictable costs with the freedom to see any licensed dentist. When members obtain care from an in-plan provider, there are no deductibles and no annual benefit maximums. Members pay a copay only for services that they receive — there is no charge for preventive care office visits. 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 maximum annual benefit is $2,000, both in-plan and out-of-plan, and there is a $50 deductible per person.
In Maryland and Virginia, employers can enhance the Kaiser Permanente medical coverage they offer with one of the following dental options, available for purchase as riders. Plan names vary across Maryland and Virginia but have identical benefits. All the dental plans offer comprehensive coverage of the full range of common dental procedures, including preventive, basic restorative, and major restorative services. Additional coverage for cosmetic dental procedures, such as orthodontic treatments, implants, and veneers, can be purchased through the Kaiser Permanente OrthoPlus rider.
Our EPO/Copay plans combine generous or unlimited annual benefit maximums with robust in-network benefits. The PPO/C-POS plans offer the freedom to visit licensed providers outside the network of participating dentists, while remaining affordable. And the POS plans balance unlimited benefits when using in-plan dentists, with access to out-of-network coverage.
Value dental plans focus on maintaining relatively affordable premiums. The copay EPO plan and the in-network tier of the POS plans have no maximum annual benefit limits. They range from $1,000 to $1,500 for the PPO plans. Per-person deductibles range from $0 to $50 in-plan, and from $50 to $100 for out-of-network visits. One of the plans is available for adults only, and the rest are for either adults or families.
The Kaiser Permanente Smile $30 Adult Preventive offers coverage most similar to the legacy $30 preventive dental plan, and the Kaiser Permanente Smile ML Adult Dental PPO/C-POS also mirrors a legacy plan.
Our mid-tier dental riders offer higher annual benefit maximums ranging from $1,500 to $2,000 for in-plan coverage (EPOs/Copays and PPOs/C-POSs). The POS plan has no in-plan maximum annual limit. Per-person deductibles range from $0 to $75 in-plan, and from $50 to $75 for out-of-network visits. Each of the four plan options is available for adults and families.
Three PPO/C-POS dental plans make up the high-tier options. They combine generous benefits with the freedom to see any licensed dentist outside of the plan. In-plan annual benefit maximums range from $2,000 to $4,000, with per-person deductibles of $0 or $25. Each of the options is available for adults and families.
The Kaiser Permanente Smile Kids plans provide a selection of plans for children under age 19. There is an option to offer embedded dental at a copay, as well as coinsurance-based choices that provide non-embedded dental care either with or without out-of-network benefits. Four separate options are available:
Both small and mid-large employers can purchase the Kaiser Permanente OrthoPlus rider, either in addition to their dental plan or as part of a plan in which it is included. OrthoPlus provides employees with enhanced coverage for cosmetic orthodontic treatments including braces and Invisalign. Additional procedures, including implants, veneers, and teeth whitening, are included at the participating provider’s negotiated fee.
For small groups, medically necessary orthodontic coverage for children under age 19 is included in Kaiser Permanente’s health plans. This covers conditions such as cleft palate if associated with a medical diagnosis, with a referral from your primary care physician.
When purchased as part of an adult dental plan, the OrthoPlus benefit covers all family members, including children under age 19. A child-only version of the OrthoPlus rider, for children under age 19, can be added to the pediatric benefit that is included in Small Group health plans, without the purchase of an adult dental plan. There is a lifetime benefit limit of $1,000 per individual.
When purchased by mid-size/large employers, OrthoPlus rider covers can be paired with an adult or family dental rider, or with a pediatric dental rider. Four levels of benefit are available, with a lifetime limit of $1,000, $1,500, $2,000, or $2,500 per individual. Each mid-size/large plan has a corresponding cosmetic orthodontic benefit, that varies according to the richness of the associated dental plan. OrthoPlus riders can be selected for adult-only, child-only, or family plans.
