Public Employees Benefits Board (PEBB) — A group of representatives, appointed by the governor, who approves insurance benefit plans for employees and their dependents, and establishes eligibility criteria for participation in insurance benefit plans. Public Employees Benefits Board (PEBB) Program — The HCA program that administers PEBB benefit eligibility and enrollment. Resin-based Composite — Tooth-colored filling, made of a combination of materials, used to restore teeth. Retired Employee of a Former Employer Group — includes a retired employee from a PEBB employer group and a retired school employee from a SEBB employer group who is continuing enrollment in PEBB health plan coverage by self-paying premiums after losing eligibility for PEBB retiree insurance coverage upon the employer group ending participation in insurance plans and contracts with the health care authority (HCA). School Employees Benefits Board (SEBB) — A group of representatives, appointed by the governor, who designs and approves insurance benefit plans for school employees and their dependents, and establishes eligibility criteria for participation in insurance benefit plans. School Employees Benefits Board (SEBB) Organization — A public school district or educational service district or charter school established under Washington State statute that is required to participate in benefit plans provided by the School Employees Benefits Board (SEBB). School Employees Benefits Board (SEBB) Program — The program within HCA that administers insurance and other benefits for eligible school employees and eligible dependents. SEBB Employer group — for the School Employees Benefits Board (SEBB) Program means an employee organization representing school employees and a tribal school as defined in RCW 28A.715.010, obtaining employee benefits through a contractual agreement with the Health Care Authority (HCA) to participate in benefit plans developed by the SEB board. Specialist — A licensed dentist who has successfully completed an educational program accredited by the Commission of Dental Accreditation, two or more years in length, as specified by the Council on Dental Education or holds a diploma from an American Dental Association-recognized certifying board. State agency — An office, department, board, commission, institution, or other separate unit or division, however designated, of the Washington state government. It includes the legislature, executive branch, and agencies or courts within the judicial branch, as well as institutions of higher education and any unit of state government established by law. Subscriber — Eligible employee, retiree, continuation coverage enrollee, retired employee of a former employer group, or survivor who has been determined eligible and is enrolled in this dental plan, and is the individual to whom the PEBB Program or this Plan will issue notices, information, requests, and premium bills on behalf of an Enrollee. Choosing a Dentist Once you choose a dentist, tell them that you are covered by a DDWA dental plan and provide them the name and number of your group and your member identification number. You may obtain your group information and your member identification number by calling our customer service number at 800-554-1907 or through our website at www.DeltaDentalWA.com. Delta Dental of Washington uses a randomly selected identification number or universal identifiers to ensure the privacy of your information and to help protect against identify theft. Please note that ID cards are not required to see your dentist, but are provided for your convenience. Delta Dental Participating Dentists Delta Dental Participating Dentists have agreed to provide treatment for enrolled persons covered by DDWA plans. Just tell your dentist that you are covered by a DDWA dental Plan and provide your identification number, 2024-01-03000-BB 5 LG PPOL 20240101