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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 on theme: "Good oral hygiene and regular dental care is important throughout your life. This Presentation is for training purposes only – See policy for complete."— Presentation transcript:

1 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

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

3 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

4 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

5 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

6 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

7 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 19 - 1 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

8 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

9 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

10 State ZipAreaZipAreaZipAreaZipArea AlabamaFloridaIndianaMississippi All3320-3224460-4666386-3912 Arizona3233467-47953923 All4324-3284Iowa3932 Arkansas3295All6394-3954 All6330-3316Kansas 396-3973 California33276604Missouri 9009333-3346661-6625630-6334 901-928335-3374664-6794634-6513 930-9377338-3445Kentucky 6524 9388346-3494All3653-6583 9399Georgia Louisiana Nebraska 9408300-3104700-7015All3 94193115703-7083Nevada 942-94883124710-7114889-8905 9619313-3195712-71438915 949-95673994Michigan 8937 9578Illinois480-4835894-8969 95876006484-48548979 9597601-604548548987 96076054486-4918New Mexico 9619606-6085492-49610All6 Colorado609-6283497-4988North Carolina All662934998All10 State ZipAreaZipAreaZipAreaZipArea OhioPennsylvaniaTexas 430-43431823763679710 4354183-18547644798-7993 436-4393186376538853 440-4414187-18947665Utah 4423190-19267673840-8437 443-444219347685844-8478 445-4533194-19657694 Virginia 4544South Carolina77062016 455-459329057726220-2225 Oklahoma291-2926773-77452236 All329357757224-2363 Pennsylvania2946776-7784237-2384 150-1514295-2997779-7843239-2463 152-1543Tennessee785-7874West Virginia 155-156237027885All6 1573371-38037894Wisconsin 1582381-38527905530-5358 159-1663Texas79145379 1672733479255388 168-1773750-753579335398 1784754-75837944540-5498 179375957956Wyoming 180-1814760-76247965All8 Area Rating Factors Based Three Digit Zip Code Choice Plus Dental

11 Rates Are Based On Resident Zip Code Area Child Only Rates Are Not Available Standard ($1,500 Annual Benefit) Area2345678910 Individual17.3018.4019.5020.7022.0023.4024.9026.4028.00 Individual +Spouse31.4033.4035.5037.7040.1042.6045.3048.2051.20 Individual + Child(ren)32.3034.3036.5038.7041.2043.8046.5049.5052.60 Family47.5050.6053.8057.1060.8064.6068.7073.0077.70 Enhanced ($2,000 Annual Benefit) Area2345678910 Individual19.4020.6021.9023.2024.7026.2027.9029.6031.50 Individual +Spouse35.4037.7040.0042.5045.2048.1051.1054.3057.80 Individual + Child(ren)36.3038.6041.1043.6046.4049.3052.4055.7059.30 Family53.6057.0060.6064.4068.5072.9077.5082.4087.60 Choice Plus Dental $25 Application Fee For Individual Applications. Application Fees are waived for list bill business with 3 or more employees.

12 www.careington.com/co/PAL PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

13 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

14 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

15 Provider Search PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

16 Provider Search Results For 75070 Step 4 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

17 www.careington.com/co/PAL Administered by: Careington International Corporation 7400 Gaylord Parkway Frisco, TX 75034 Toll Free Service Line 855-332-1271 PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY SM

18 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

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


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