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Dental Plans Offered by Kaiser Permanente Insurance Company
The Kaiser Permanente Insurance Company (KPIC) Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) summarizes important information about your dental coverage options. This information includes:
- The annual overall policy deductible.
- The annual benefit limit.
- Coverage for the following categories:
- Preventive and diagnostic services.
- Basic services.
- Major services.
- Orthodontia services.
- Dental policy reimbursement levels and estimated insured cost share for service.
- Waiting periods.
- Examples to illustrate coverage and estimated insured costs of commonly used benefits.
If you have questions about the SDBC you may contact our customer service at 1-800-835-2244 (TTY/TDD 711) Monday through Friday between 8:00 am and 8:00 pm, Pacific Standard time.
If you require a copy of the SDBC you may contact 1-800-788-0710 Monday through Friday between 8:00am and 8:00PM, Pacific Standard Time.
- 2024 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult Dental Coverage Only (PDF)
- 2024 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult and Family Coverage (PDF)
- 2024 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Federal Dental Plan (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AH (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AG (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - School of Medicine (SOM) (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 with Ortho (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1500 (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D1500 (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan G (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E With Ortho (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D (PDF)
- 2024 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan C (PDF)
- 2023 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult Dental Coverage Only (PDF)
- 2023 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult and Family Coverage (PDF)
- 2023 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Federal Dental Plan (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AH (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AG (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - School of Medicine (SOM) (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 with Ortho (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1500 (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D1500 (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan G (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E With Ortho (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D (PDF)
- 2023 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan C (PDF)
- 2022 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult Dental Coverage Only (PDF)
- 2022 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Adult and Family Coverage (PDF)
- 2022 Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) - Federal Dental Plan (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AH (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan AG (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - School of Medicine (SOM) (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 with Ortho (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1500 (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E1000 (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D1500 (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan G (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E With Ortho (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan E (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan D (PDF)
- 2022 Summary of Dental Coverage Disclosure Matrix (SDBC) - Plan C (PDF)
Looking for information for Southern California? Please visit the KPIC Southern California Summary of Dental Benefits and Coverage Disclosure (SDBC) page.
*These dental insurance plans are underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., and administered by Delta Dental of California.*
The Adult Dental plan and Adult and Family Dental plan are only available to Kaiser Permanente Individual and Family (KPIF) members.