› No Waiting Periods 100/80/10 1st 12 Months
100/80/50 13th Month After
› $100 Lifetime Deductible For All Classes
› No Participation Requirements Minimum of Only 2 Lives
› Choose Any Dentist Total Freedom of Choice
› Calendar Maximums $1,000 1st Year $1,250 2nd Year $1,500 3rd Year & After
› Orthodontics Available
Choose any
Dentist!
100% Usual, Reasonable, and
Customary Benefits
No Deductible
TYPE I – PREVENTIVE SERVICES
Two exams per year; Two Cleanings per year; One topical fluoride per year to age 16; One series of bitewing x-rays per year
80% Usual, Reasonable, and
Customary Benefits
TYPE II – BASIC SERVICES
Basic filings; Space maintainers; Sealants (children to age 16); Simple Extractions
10% Usual, Reasonable, and
Customary Benefits
50% after One Year
TYPE III – MAJOR SERVICES
Oral Surgery; Endodontic Treatment; Periodontic services; Crowns, inlays and onlays; Prosthetic services, bridges and dentures; One diagnostic
x-ray, full or panoramic in any 3 year period.
$100.00
Lifetime
Per
Person
Lifetime deductible applies only to:
TYPE I – BASIC SERVICES
TYPE II – MAJOR
SERVICES
TYPE III – MAJOR
PROSTHETIC SERVICES
$1,000 Year 1
$1,250 Year 2
$1,500 Year 3
POLICY YEAR MAXIMUM –
Per person per policy year. Applies
to all types of services.
