The plan provides benefits for diagnostic and preventive care as well as most forms of specialty dental treatment. You may go to any dentist you wish.
The Schedule of Dental Services identifies the maximum allowable benefit you and your dependents receive when a procedure is performed. The dollar amount assigned to each procedure is the maximum you receive, not to exceed actual charges. Under this Plan, you can request to have benefits paid either directly to the dentist or you can be reimbursed for the benefit.
Option to use the SmileMax® Dental Network which can result in lower out-of-pocket costs for your dental care
This Dental Plan includes an optional PPO feature through the SmileMax® Dental Network which can help reduce your out-of-pocket expenses. The SmileMax® network is a group of dental professionals at more than 140,000 locations nationwide that have contracted to provide dental services at negotiated fees. Selecting a network dentist can also help ensure quality care, because all network dentists are screened according to a rigorous credentialing process. Members are encouraged to use a network dentist in the SmileMax network when accessing dental services. When a network dentist is selected, you will be charged pre-arranged fees that are guaranteed to be at or under the dentist’s usual fee. On average, a savings of 20 to 40 percent have been achieved nationally when using a network dentist. The Enhanced Dental Insurance Plan will continue to pay at the levels shown in the Schedule of Dental Services and you will be responsible for the difference between the network dentist’s negotiated fee and the amount paid by this plan. But your out-of-pocket costs will be significantly reduced because the network dentist’s negotiated fee is less than the dentist’s usual fee. You may continue to choose any dentist you wish. However, using a SmileMax network provider can help you save significantly. To find a SmileMax dentist, call 1-800-221-3480 or visit SmileMax Dental Provider,an online search tool . If your dentist does not currently participate in the SmileMax® Dental Network, you can contact the program administrator to obtain a nomination form to nominate him/her for membership.
Members And Eligible Dependents May Enroll
You and your eligible dependents may enroll for coverage. Eligible dependents include a lawful spouse and dependent children typically under age 21 (age 25 if a full–time student). (Subject to state variations.) All persons who were previously insured for dental insurance under this plan and later voluntarily ended insurance will not be eligible to re-enroll for a period of two years following the date insurance was voluntarily ended.
Dental Plan Features
- You select your own dentist – guaranteed.
- Benefits are provided for 155 different dental services.
- Option to use the SmileMax® Dental Network
- No deductible for preventive services.
- No waiting period for preventive, diagnostic, restorative (except major) or adjunctive servies.
- Choose to have the benefits paid to you or directly to the dentist.
- Your acceptance into this plan is not subject to underwriting approval.
You and your covered dependents are entitled to receive up to $1,200 maximum in dental benefits each calendar year after the cash deductible is satisfied. A lifetime maximum benefit of $850 applies to orthodontic services for insured dependent children under age 19.
The calendar year deductible is $50 per insured person, up to $150 maximum per family unit. The deductible does not apply to preventive services. It is applied against insurance–covered expenses, not billed charges.
Preventive, Diagnostic, Restorative (except major) and Adjunctive Services are provided immediately. Endodontics and Oral Surgery services have a 6–month waiting period. All other services have a 12–month waiting period. Once you have been enrolled under the plan for 12 consecutive months, you are eligible for services under Restorative–Major, Periodontics, Prosthetics–Removable and Fixed Bridge. For orthodontic services for insured dependent children under age 19, there is a 12–month waiting period.