Preventive services and fillings are covered to help keep your smile healthy
Dental Insurance Shield provides...
$0 Deductible
$1,000 Annual maximum
Dental Insurance Shield
Preventive services and fillings are covered to help keep your smile healthy
No waiting periods on diagnostic and preventive Low deductible $1,000 annual maximum
| Waiting Period | In-Network Dentist | Out-of-Network Dentist | |
|---|---|---|---|
| DIAGNOSTIC & PREVENTIVE | |||
| Oral Exams & Cleanings | No | 100% | 70% |
| Bitewing and all other radiographs | |||
| Fluorides | |||
| MINOR SERVICES | |||
| Fillings | 6 Months | 60% | 50% |
| Periodontal Prophylaxes | |||
| Denture Repair | |||
| Other Adjunctive | |||
| MAJOR SERVICES | |||
| Major Restorative | Not covered** | 0% | 0% |
| Endodontics | |||
| Periodontics | |||
| Simple Extractions | |||
| Complex Oral Surgery | |||
| Prosthodontics - bridges and dentures | |||
| Prosthodontics - Implants | |||
| Policy Year Maximum — Per Member | $1,000 | $1,000 | |
| Policy Year Deductible — Per member/per family | $50/$150 | $50/$150 | |
| Out-of-Network Reimbursement | PPO Schedule | ||
| Orthpdontic Annual Maximum* | $0 | $0 | |
* In and out-of-network values will not vary
** Family deductible will be three times the individual deductible where applicable
EXCLUSIONS AND LIMITATIONS
NOTES: The enclosed summaries are samples of benefits. Policies have exclusions and limitations (see some highlights below) that may limit coverage. Renaissance Dental plan Ren Essentials (PPO BASIC) may not be available in all states. For complete coverage details including the full list of Exclusions and Limitations, please refer to your policy, INVD-100A-(state abbreviation, if applicable).
EXCLUSIONS: Cosmetic surgery or dentistry for aesthetic reasons (except reconstructive surgery for children because of congenital disease or anomaly); general anesthesia and/or intravenous sedation; treatment by anyone other than a licensed dentist or dental hygienist; veneers, sealants, periodontic services (to treat gum disease), endodontic services (root canals), prosthodontics (bridges, implants and dentures), oral surgery services (extractions and dental surgery), relines and repairs (to bridges and dentures), crown and cast restorations (metal and porcelain crowns), coverage for temporomandibular disorders (TMD); appliances, procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Policy and/or Summary of Dental Plan Benefits.
LIMITATIONS: Coverage for services may be limited based on the age of the person receiving services and coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years).
ADDITIONAL INFORMATION
The premium rate will vary between plans. The policy has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with the policy provisions. Coverage may be terminated for reasons stated in the policy. Coverage ceases upon termination of the policy. Products and services referred to in this brochure may not be available in all states or jurisdictions.
