DentaCert Enhanced Plan Details
P
reventive Care - No waiting Period
Office Visit
$10 co-pay, 1 visit per year per member
Preventive
Plan pays one Annual Visit w/$10 co-
pay. Pays for Oral Exams, including Prophylaxis, Sealants up to age 13/ Topical Fluoride up to age 19.
Diagnostic Care - No waiting Period
Diagnostic
Bitewing X-Ra
ys, 1 per 12 months. Full mouth x-rays, plan pays 100% of maximum covered expense, 1 per 36 months.
Deductible
Individual - $100 Lifetime
Family Limit - NONE
Basic - No Waiting Period
Basic Procedures
Simple Extractions Fillings, Repairs have no waiting period. Plan pays according to schedule.
Major - 6 Month Waiting Period
Major Procedures
Periodontics, Endodontics, Oral Surgery, Crowns, Dentures, Bridges, and Implants, have a 6 month waiting period. Plan pays according to schedule.
Orthodontics - No Waiting Period (Network Savings)
Orthodontics Services
Insurance coverage not available. Network sa
ving discounts apply.
Orthodontic treatment for dependent children under age 19
Annual Maximum Benefit
$1000
2009- ICB America -
