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Plan Highlights

This top dental insurance plan is designed for people who need coverage for both preventive and major dental procedures. Our MAX plan has a generous annual maximum of $3,000 with 60% coverage on Major Procedures and includes coverage for orthodontic procedures (until 19 years of age)***.

Benefits Summary

Top dental insurance with COVERAGE AS SHOWN

IN-NETWORK

OUT-OF-NETWORK

Diagnostic & Preventive Services – No Waiting Period, No Deductible

Diagnostic & Preventive Services – exams, cleanings and Bitewing Radiographs – X-rays
Brush Biopsy – to detect oral cancer
Sealants – to prevent decay of permanent molars

100%

Basic Services – 6 Month Waiting Period**

Emergency Palliative Treatment – to temporarily relieve pain
Other Radiographs – other than bitewing X-rays
Minor Restorative Services – fillings

80%

Major Services – 12 Month Waiting Period***

After Hours Visits – services performed by a dentist during after-hours visits
Major Restorative Services – crowns
Periodontal Maintenance – following active periodontal therapy
Periodontic Services – to treat gum disease
Prosthodontic Services – bridges, implants and dentures
Relines and Repairs – to bridges, implants and dentures
Endodontic Services – root canals
Oral Surgery Services – simple and complex extractions and dental surgery
Other Major Services – occlusal guards, and limited occlusal adjustments

60%

Orthodontics – 12 Month Waiting Period***

Orthodontic Services – braces (until 19 years of age)

60%

Orthodontic Lifetime Maximum

$1,200

Maximums & Deductibles

Policy Year Maximum applies to Diagnostic & Preventive, Basic and Major Services

$3,000.00

Policy Year Deductible – per enrollee/per family per policy year. Applies to all services except Diagnostic & Preventive Services and Orthodontics.

$50/$150

Allowed Amounts

Allowed amount – fee schedule for in-network and out-of-network providers

PPO fee

Note: The above schedule of benefits is meant to be a summary of coverage. Please see the insured certificate for a legal interpretation of benefits. Underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN, and in New York by Renaissance Life & Health Insurance Company, P.O. Box 1596, Indianapolis, IN 46206. Products not available in all states and jurisdictions.

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