| Dental Procedures |
Value Plan A |
Enhanced Plan B |
Premium Plan C |
|
|---|---|---|---|---|
| Office Visit: |
(1) Office visit per year per
member. (1) Comprehensive Oral Exam (1) Consultation (Other treating doctor) |
No Co-pay No Waiting Period |
$10 Co-pay No Waiting Period |
$10 Co-pay No Waiting Period |
| Preventive: |
Plan pays one Annual Visit. Pays
for Oral Exams, including Propylaxis, Sealants/Topical Fluoride. |
No Cost No Waiting Period |
Paid Per Schedule No Waiting Period |
Paid Per Schedule No Waiting Period |
| Diagnostic: |
Bitewing X-Rays 1 per 12 months.
Full mouth x-rays 1 per 36 month |
No Cost No Waiting Period |
Paid Per Schedule No Waiting Period |
Paid Per Schedule No Waiting Period |
| Basic: |
Simple Extractions Fillings,
Repairs have no waiting period. Plan pays according to schedule. |
No Waiting Period Network Discounts from 15%-50% |
Paid Per Schedule No Waiting Period |
Paid Per Schedule No Waiting Period |
| Major: |
Periodontics,
Endodontics, Oral Surgery, Crowns, Dentures, Bridges, and Implants,
have a 6 month waiting period. Plan pays according to schedule. |
No Waiting Period Network Discounts from 15%-50% |
6 Month Waiting Period Paid Per Schedule |
6 Month Waiting Period Paid Per Schedule |
| Orthodontics: |
Insurance coverage available on
Plan C. Network saving discounts are available on Plan A, B and C. |
No Waiting Period Network Discounts from 15%-50% |
No Waiting Period Network Discounts from 15%-50% |
12 Month Waiting Period $500 Annual Max $1,000 Lifetime Max |
| Deductible: | None |
Individual - $100 Lifetime Family Limit - None |
Individual - $100 Lifetime Family Limit - None |
|
| Annual Maximum: |
Amount of insurance dollars paid
for benefits per person per year. |
N/A |
$1,000 Max per year per person |
$1,500 Max per year per person |