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InsuranceCompany.com is a specialist in
dental insurance plans, vision and prescription coverage programs. We
have
been in the dental business since 1983 and
offer several national dental, vision and
prescription
programs depending upon the
state you live in...
You have selected a dental insurance plan from Delta Dental©
Insurance Company managed by Benefits Association
Since 1970, Delta
Dental© Insurance Company and its affiliates have provided dental insurance to more
than one million enrollees in 10 states. Benefits Association, the plan
administrator, is a member of the national Delta
Dental Plans Association, which covers more than 42 million enrollees and
includes the participation of more than 100,000 dentists. This dental insurance
plan from Delta Dental©
Insurance Company is managed by Benefits AssociationThis plan includes dental insurance, eye care
(vision) program and discount prescription (Rx).
| Your online request must be
processed on or before the 15th of the month prior to the coverage effective
date. This dental plan starts on the 1st of next month if you have enrolled by
the 15th of this month... If you have any questions regarding the enrollment period please
contact
our office for assistance. |
Area
7
SCHEDULE
OF DENTAL BENEFITS
Delta Dental© Insurance Company |
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Waiting Period |
Plan Pays
(1st Year) |
Plan Pays
(2nd Year) |
Plan Pays
(3rd Year) |
Services Covered
$1200 Maximum Calendar Benefit Per Person |
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No Waiting Preventive
Dental Services
Benefits Begin Immediately |
80% |
90% |
100% |
Type 1:
Diagnostic and Preventative Treatment
$50 Deductible Per Person Per Year
Diagnostic:
Routine periodic examinations once in a 6 month period.
Preventative: Dental prophylaxis (teeth cleaning and
scaling) once in a 6 month period (including application of
topical fluoride for dependent children only).
Radiography: Bitewing x-rays once in a 6 month period.
Full mouth x-rays once in a 36 month period. |
Basic
Services
Benefits Begin After 6 Months |
60% |
70% |
80% |
Type 2: Basic
Procedure
$50 Deductible Per
Person Per Year
Restorative:
Amalgam, synthetic porcelain or plastic fillings
Other: Space maintainers, recementation of crowns |
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Major
Services
Benefits Begin After 12 Months |
0% |
40% |
50% |
Type 3:
Major Procedures
$50 Deductible
Per Person Per Year
Endodontics:
pulpal therapy and root canals.
Periodontics: Treatment of diseases of the gums.
Prosthetics: Gold restorations, crowns, bridges,
partial and complete dentures. For enrollees of age 65 or
older this benefit is limited to $600 per person per year.
Oral Surgery: Extractions and other oral surgery,
including pre- and postoperative care
Other: Pontics, repair of crowns and bridges, full and
partial denture repair. |
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Major
Services
Benefits Begin After 12 Months |
0% |
40% |
50% |
Type 4:
Orthodontia Procedures
$100 Deductible Lifetime Per Person
This benefit only
applies to covered dependents up to age 19. $350 benefit per
year maximum. $1,000 lifetime maximum per person for this
benefit. |
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Limitations on all Benefits - Optional Services:
Services that are more expensive than the form
of treatment customarily provided under accepted dental practice standards are
called "Optional Services." Optional Services also include the use of
specialized techniques instead of standard procedures. For example: a crown
where a filling would restore the tooth, a precision denture where a standard
denture could be used, or an inlay instead of a restoration. If you receive
Optional Services, your Benefits will be based on the lower cost of the
customary service or standard practice instead of the higher cost of the
Optional Service. You will be responsible for the difference between the
higher cost of the Optional Service and the lower cost of the customary
service or standard practice.
Exclusions
Delta Dental does not pay Benefits for:
- Services for injuries or conditions which are
compensable under workers' compensation or employers' liability laws; services
which are provided to the Enrollee by any federal or state government agency
or are provided without cost to the Enrollee by any municipality, county or
other political subdivision except as such exclusion may be prohibited by law.
- Services with respect to congenital
(hereditary) or developmental (following birth) malformations or cosmetic
surgery or dentistry for purely cosmetic reasons, including but not limited to
cleft palate, maxillary and mandibular (upper and lower jaw) malformations,
enamel hypoplasia (lack of development), fluorosis (a type of discoloration)
of the teeth, and andontia (congenitally missing teeth), except those services
provided to newborn children for congenital defect or birth abnormalities or
services that may be provided under Orthodontic Benefits.
- Services for restoring tooth structure lost
from wear, erosion, or abrasion, for rebuilding or maintaining chewing
surfaces due to teeth out of alignment or occlusion, or for stabilizing the
teeth. Such services include, but are not limited to: equilibration,
periodontal splinting, occlusal adjustment.
- Any single procedure started prior to the date
the person became covered for such services under this program.
- Prescribed drugs, medication or analgesia
- Experimental procedures
- Charges by any hospital or other surgical or
treatment facility and any additional fees charged by the Dentist for
treatment in any such facility.
- Charges for anesthesia, other than by a
licensed Dentist for administering general anesthesia in connection with
covered oral surgery services.
- Extra oral grafts (grafting of tissues from
outside the mouth to oral tissues).
- Services with respect to any disturbance of
the temporomandibular joint (jaw joint).
- Services performed by any person other than a
Dentist or auxiliary personnel legally authorized to perform services under
the direct supervision of a Dentist.
- Teeth extracted prior to the member's
effective date are not covered benefits.
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