Monthly
Willamette Dental Oregon TrueCare Rates
  Plan 1 Plan 2
Member Only $45.30 $49.00
Member & Spouse/Partner $90.60 $98.00
Member & Children $92.90 $100.45
Member, Spouse/Partner & Children $138.20 $149.45

Premium Rates for Payments by EFT. Add $5.00 to the rates above if you want to pay by check

*Rates are valid for 12 months from the effective date of the policy. Rates are subject to change.


Willamette Dental TrueCare Benefit Summary
Annual maximum None None
Deductible None None
Benefit Plan 1 Copayments Plan 2 Copayments
General Office Visit You pay a $35 Copay You pay a $25 Copay
Specialist Office Visit You pay a $35 Copay You pay a $30 Copay
Dental Exams and X-rays You pay a $0 Copay You pay a $0 Copay
Teeth Cleaning You pay a $0 Copay You pay a $0 Copay
Fluoride Treatment You pay a $0 Copay You pay a $15 Copay
Sealants per Tooth You pay a $0 Copay You pay a $15 Copay
Filling - Amalgam You pay a $45 Copay You pay a $25 Copay
Filling - Resin (Anterior) You pay a $70 Copay You pay a $50 Copay
Filling - Resin (Posterior Primary) You pay a $80 Copay You pay a $50 Copay
Filling - Resin (Posterior Permanent) You pay a $132 Copay You pay a $102 Copay
Stainless Steel Crown You pay a $90 Copay You pay a $70 Copay
Porcelain/Metal Crown1 You pay a $500 Copay You pay a $400 Copay
Complete Denture1 You pay a $600 Copay You pay a $500 Copay
Bridge (per tooth)1 You pay a $500 Copay You pay a $400 Copay
Root Canal Therapy
– Anterior Tooth
You pay a $225 Copay You pay a $200 Copay
Root Canal Therapy
– Bicuspid Tooth
You pay a $325 Copay You pay a $225 Copay
Root Canal Therapy
– Molar
You pay a $425 Copay You pay a $250 Copay
Osseous Surgery (Per Quadrant) You pay a $325 Copay You pay a $300 Copay
Root Planing (Per Quadrant) You pay a $100 Copay You pay a $75 Copay
Routine Extraction You pay a $75 Copay You pay a $50 Copay
Surgical Extraction You pay a $190 Copay You pay a $100 Copay
Pre-Orthodontic Service2 You pay a $150 Copay You pay a $150 Copay
Comprehensive Orthodontia1 You pay a $3,000 Copay You pay a $2,800 Copay
Nitrous Oxide Per Visit You pay a $40 Copay You pay a $40 Copay
Out-of-area emergency care (50 miles or more from a WDG office) Out of area emergency treatment is reimbursed up to $100 minus applicable copayments.
  1. Benefit available after a six month waiting period.
  2. Applies toward comprehensive orthodontic copayment if patient accepts treatment plan.

Exclusions

These services and supplies are not covered:

  • Bridges, crowns, dentures or any prosthetic devices requiring multiple treatment dates or fittings if the prosthetic item is installed or delivered more than 60 days after termination of coverage.
  • The completion or delivery of treatments, services, or supplies initiated prior to the effective date of coverage.
  • Dental implants.
  • Endodontic services, prosthetic services, and implants provided prior to the effective date of coverage.
  • Endodontic therapy completed more than 60 days after termination of coverage.
  • Experimental or investigational services or supplies.
  • Exams or consultations needed solely in connection with a service or supply not listed as covered.
  • Full mouth reconstruction.
  • General anesthesia, including conscious, intravenous and moderate sedation.
  • Hospital care or other care outside of a dental office or facility fees.
  • Maxillofacial prosthetic services.
  • Nightguards.
  • Orthognathic surgery.
  • Personalized restorations.
  • Plastic, reconstructive, or cosmetic surgery.
  • Prescription and over-the-counter drugs and pre-medications.
  • Replacement of lost, missing, stolen or damaged dental appliances.
  • Replacement of sound restorations.
  • Services or supplies and related exams or consultations that are not within the prescribed treatment plan, are not recommended and approved by a Participating Dentist or are not necessary.
  • Services or supplies by any person other than a licensed dentist, denturist, hygienist, or dental assistant.
  • Services or supplies for the diagnosis or treatment of temporomandibular joint disorders.
  • Services or supplies for the treatment of an occupational injury or disease.
  • Services or supplies for treatment of injuries sustained while practicing for or competing in a professional athletic contest of any kind.
  • Services or supplies for treatment of intentionally self-inflicted injuries.
  • Services or supplies for which coverage is available under any federal, state, or other governmental program.
  • Services or supplies that are not listed as covered in the policy.
  • Services or supplies where there is no evidence of pathology, dysfunction, or disease.

This is a brief summary of benefits. For full coverage provisions, including a description of limitations and exclusions, refer to your policy.