Key Benefits:
- Use
your own dentist!
- Nationwide
coverage
- Choice
of two plan designs
Plan
I Benefits
Annual
Deductible: $50 per person per calendar year.
Annual
Maximum: $1,000 per person per calendar year
Insured
Percentage Of Allowable Charges:
- Type
I Preventative Services -- 80% first year, 100% thereafter
- Periodic
routine exams (one every 6 months)
- Prophylaxis
(cleanings - one every 6 months)
- Fluoride
treatments
- Sealants
(under age 14)
- X-Rays
- Bitewing (4 films every 6 months)
- X-Rays
- Panoramic (1 every 48 months)
- Type
II Basic Services --50% first year, 80% thereafter
- Simple
Extractions
- Fillings
- Minor
periodontics
- Root
canal therapy
- Type
III Major Services -- Not Included
Plan
II Benefits
Annual
Deductible: $50 per person per calendar year.
Annual Maximum: $1,000 per person per calendar year
Insured
Percentage Of Allowable Charges:
- Type
I Preventative Services -- Same as Plan I
- Type
II Basic Services -- Same as Plan I
- Type
III Major Services -- First Year - 10%; Second Year - 25%;
Third Year Forward - 50%
- Complex
oral surgery
- Major
periodontics
- Inlays,
onlays, crowns and bridges
- Partial
and complete dentures
Orthodontic
services are not covered under either plan
Initial
benefits are subject to a 2 month waiting period
after the effective date on both plans
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