|
|
|
|
DENTAL PLAN COVERAGE INFORMATION
Benefits will be paid for reasonable and customary fees as defined by the plan policy. This plan has a maximum calendar year benefit for all services of $1,000, $1,500 or $2,000 per person depending on plan chosen. Six Month waiting period for Basic Services, 18 Month waiting period for Major Services applies.
| PREVENTIVE |
You Pay... |
| Two routine exams of mouth and teeth per calendar year |
$50 Calendar year deductible* |
| Two cleanings, scalings, and polishings per calendar year |
$50 Calendar year deductible* |
| Space maintainers |
$50 Calendar year deductible* |
| BASIC SERVICES |
You Pay... |
| Extraction of teeth |
20% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| X-rays |
20% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Pin Retention of filings |
20% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Fillings |
20% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Antibiotic injections |
20% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| MAJOR SERVICES |
You Pay... |
| Oral Surgery |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Endodontic treatment of disease |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Periodontic services |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Crown build up for non-vital teeth |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Recementing |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Denture or bridge repair |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| General anesthesia and analgesic |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Restoration services |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
| Prosthetic services |
50% Coinsurance, $50 per member Calendar year deductible if under age 65* |
* You only have to pay one calendar year deductible across all classes of benefits. $50 Member deductible, $100 Member plus one deductible, $150 Family deductible. $75 Member deductible, $150 Member plus one, $225 Family deductible for ages over 65.
OVERAGE ELIGIBILITY
All members and their spouse, regardless of age, and their children under 19 (23 if a full-time student) can enroll in this comprehensive dental coverage. Six Month waiting period for Basic Services, 18 Month waiting period for Major Services applies.
ELIGIBLE EXPENSES
For the plan to pay for covered expenses, a covered person must incur all eligible expenses while the policy is in force. Eligible expenses are dental services performed by:
- a licenses dentist action within the scope of his license,
- a licensed physician performing dental services within the scope of his license, or
- a licensed dental hygienist acting under the supervision and direction of a dentist.
|
E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
Copyright© 1998-2008, Maddock & Associates | Privacy Statement
Problems viewing this page? Contact the webmaster.
|
|
