Pediatric dental coverage is included in Maryland, Virginia, and District of Columbia health plans for children until the end of the month in which they turn age 19.
Adult dental options are highly complementary to the embedded child dental benefits and 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 and Virginia.1 They are not available in the District of Columbia.
Available as a separate rider, OrthoPlus provides enhanced coverage for cosmetic orthodontic treatments, including braces and lnvisalign. Implants, veneers, teeth whitening, and more, are also included at the participating provider’s negotiated fee.
1In the NCQA Commercial Health Plan Ratings 2023, our commercial plan is rated 5 out of 5, the highest rating in the region.
Dental plans with the same benefits are referred to respectively as EPO and PPO plans in Maryland, and Copay and C-POS plans in Virginia.
The KP Smile Kids KPIF Embedded Dental EPO (MD) / Copay (VA) provides dental benefits for children aged 18 and younger. It has predictable copays and no overall limits on annual benefits. Deductibles may apply depending on the provisions of the medical plan. Catastrophic-tier health plans and state-mandated plans in the District of Columbia and Maryland have customized versions of this plan.
The KP Smile Kids KPIF Embedded Dental EPO (MD) / Copay (VA) 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.
In Maryland and Virginia, you can enhance your Kaiser Permanente medical coverage with one of the following dental options, available for purchase as riders (open to those age 19 and older):
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 for the full range of common dental procedures, including preventive, basic restorative, and major restorative services. Adding the OrthoPlus rider offers coverage for enhanced cosmetic orthodontic procedures.
This plan gives members access to a network of high-quality in-plan providers, plus the freedom to see any licensed dentist outside of the plan. With in-plan dentists, members receive 80% coverage (member pays 20%) 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. Adding the OrthoPlus rider offers coverage for enhanced cosmetic orthodontic procedures. The maximum annual benefit covered is $1,000, both in-plan and out-of-plan, and there is a $50 deductible per person.
This plan offers a richer alternative to the KP Smile KPIF Dental PPO Basic plan. It gives members access to a network of high-quality in-plan providers, plus the freedom to see any licensed dentist outside of the plan. With in-plan dentists, members receive 100% coverage (member pays nothing) 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. Adding the OrthoPlus rider offers coverage for enhanced cosmetic orthodontic procedures. There is no deductible, and the maximum annual benefit covered is $1,500, both in-plan and out-of-plan.
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.
Enhanced coverage for cosmetic dental procedures — including implants, veneers, and orthodontic treatments like braces — is available with plans that include the OrthoPlus rider. When added to 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.
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