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  
Deductible 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 $5 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.