Good oral hygiene and regular dental care is important throughout your life. This Presentation is for training purposes only – See policy for complete.

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Presentation transcript:

Good oral hygiene and regular dental care is important throughout your life. This Presentation is for training purposes only – See policy for complete benefit description Choice Plus Dental

Introducing a new type of “hybrid” dental insurance policy that combines traditional fully insured benefits with PPO discount pricing. Choice Plus Dental

Freedom of Choice Unlike many PPO plans that will not pay anything if you go outside their network, Dental Choice Plus will pay the non- network provider at the same rate as if they were in network. Your client will only be responsible for the non-network charges that are in excess of the pre-negotiated network fee schedule. Choice Plus Dental

INDIVIDUAL DENTAL PLAN NO WAITING PERIODS ON DIAGNOSTIC AND PREVENTIVE CARE BENEFITS. DIAGNOSTIC & PREVENTIVE PAID AT 100% WHEN USING A NETWORK PROVIDER. TWO PLAN OPTIONS TO CHOOSE FROM WITH CALENDAR YEAR MAXIMUMS BENEFITS OF EITHER $1,500 OR $2,000. OVER 169,000 ACCESS POINTS ACROSS THE UNITED STATES. EAPPLICATION ENROLLMENT EMPLOYER SPONSORED PLAN IN ADDITION TO THE KEY BENEFITS LIST FOR INDIVIDUAL PLANS, EMPLOYER SPONSORED PLANS ARE AVAILABLE. AVAILABLE FOR GROUPS OF 3 OR MORE $25 APPLICATION FEE IS WAIVED LIST BILL EAPPLICATION ENROLLMENT RATES FOR AGES 65+ Choice Plus Dental

Dental Choice Plus Benefits Reimbursement Method In/Out Standard Plan Pays** Yr. 1 / Yr. 2 / Yr. 3+ Enhanced Plan Pays** Yr. 1 / Yr. 2 / Yr. 3+ Diagnostic & Preventative No Wait100% / 100% / 100% Basic (Filings & Simple Extraction)Basic6 months 50% / 65% / 80% EndodonticMajorNo Wait 0%* / 25% / 50% PeriodonticsMajorNo Wait 0%* / 25% / 50% Oral SurgeryMajorNo Wait 0%* / 25% / 50% RestorationsMajorNo Wait 0%* / 25% / 50% OrthodonticsMajorNo Wait 0%* / 25% / 50% ProsthodonticsMajorNo Wait 0%* / 25% / 50% Co-Pay (Per Person, Per Visit) No more than 3 per person per calendar year $25 Thru age 64 $40 over age 65 $25 Thru age 64 $40 over age 65 Insurance Calendar Year Maximum per person per calendar year$1,500$2,000 Orthodontic and Prosthodontics Lifetime Maximum ($1,000 Lifetime Max, Limited to $350 per Calendar Yr.) $1,000 * Insured pays only the discounted pre-negotiated network provider rate. $25 Application Fee For Individual Applications. Application Fees are waived for employer sponsored plans **Annual coinsurance amounts are based on policy years. Choice Plus Dental

Good oral hygiene and regular dental care is important throughout your life Given the suspected link between periodontitis and systemic health problems, prevention is the first step to maintain good long-term health. Dental Choice Plus is economical because it focuses on benefits you need…not benefits you may never use. Diagnostic & Preventive Services are paid at 100% with only a $25 co-pay when using a network provider. No waiting periods or deductibles. Choice Plus Dental

Examples of Diagnostic & Preventive Services when receiving benefits through PPO Waiting Periods Amount Paid Routine oral exams - 1 exam per 6 month period No Waiting Period 100% Bitewing X-rays (up to a set of 4) - 1 set per Calendar Year No Waiting Period 100% Full Mouth X-rays (Panoramic Film or Full Series) - no less than 36 months apart No Waiting Period 100% Prophylaxis (cleaning and scaling of teeth) - 1 per Calendar Year No Waiting Period 100% Topical application of Fluoride for dependent children under per Calendar Year No Waiting Period 100% Consultation - other than treating doctor No Waiting Period 100% Comprehensive Oral Exam No Waiting Period 100% Sealant - dependents under 14, one treatment per tooth no less than 36 months apart No Waiting Period 100% Space Maintainers - the initial appliance for dependent children under 13, including adjustments within the 6 month period immediately following installation No Waiting Period 100% Diagnostic & Preventative Services paid at 100% No Waiting Periods Dental Choice Plus focuses on providing the benefits you need to maintain good oral health at affordable prices Choice Plus Dental

The schedule applies to services provide by a participating General Dentist and is an extensive list of most common procedures. The purpose of this schedule is to establish the maximum fee that a General Dentist will charge for each listed procedure. Fee schedules are determined by the zip code of the participating provider. Participating Specialists do not charge according to this fee schedule but will give a 20% discount. Care PPO Schedule CI-3

If the annual calendar year maximum benefit is exhausted, you can still take advantage of the pre-negotiated network provider’s fee schedule as long as you use a participating network provider. With over 169,000 access points across the United States Care PPO pre-negotiated fee schedule will apply to give continued savings even after the insured benefits are exhausted. If you go to a participating network provider who resides in a higher cost area we will pay based on the point of service provider at no additional cost. Choice Plus Dental

State ZipAreaZipAreaZipAreaZipArea AlabamaFloridaIndianaMississippi All Arizona All Iowa3932 Arkansas3295All All Kansas California Missouri Kentucky All Georgia Louisiana Nebraska All Nevada Michigan Illinois New Mexico All6 Colorado North Carolina All All10 State ZipAreaZipAreaZipAreaZipArea OhioPennsylvaniaTexas Utah Virginia 4544South Carolina Oklahoma All Pennsylvania Tennessee West Virginia All Wisconsin Texas Wyoming All8 Area Rating Factors Based Three Digit Zip Code Choice Plus Dental

Rates Are Based On Resident Zip Code Area Child Only Rates Are Not Available Standard ($1,500 Annual Benefit) Area Individual Individual +Spouse Individual + Child(ren) Family Enhanced ($2,000 Annual Benefit) Area Individual Individual +Spouse Individual + Child(ren) Family Choice Plus Dental $25 Application Fee For Individual Applications. Application Fees are waived for list bill business with 3 or more employees.

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Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

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Provider Search Results For Step 4 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

Administered by: Careington International Corporation 7400 Gaylord Parkway Frisco, TX Toll Free Service Line PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

DENTAL CHOICE PLUS STATE APPROVALS AK OR NV AZ TX LA AR MO KS NE IA MS AL GA FL IL IN OH KY WV VA PA HI WI CA ID MT WY WA UT CO NM OK SD ND MN TN SC NC MI VT ME NY 3_14 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

Choice Plus Dental Finally, a dental policy that covers the services you want at a price you can afford.