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California Dental Insurance $1500 Max Platinum Plan Underwritten by Delta Dental Insurance Company

04/26/11 6:05 AM

Reviewing the Dental Insurance $1500 Max Platinum Plan Underwritten by Delta Dental Insurance Company. This dental insurance plan provides individual and family dental benefits. A family membership covers the applicant, spouse, and your dependent children ages 25 or younger. The dental insurance plan offers your choice of dentist and you can change your dentist anytime by notifying the company. Your savings are in place when you visit your dentist so you just show up for your dental appointment and make your co-payment – what could be easier? Dental health care and orthodontic coverage is included for dependent children.

There is no waiting period for your preventive services to start. Please review the dental benefit co-payments below and see how easy it is for you or your entire family to enjoy these quality dental services. Just a reminder your online request must be processed on or before the 20th of the month prior to the following month’s coverage effective date.

Limitations on all Benefits – Optional Services:

Services that are more expensive than the form of treatment customarily provided under accepted dental practice standards are called “Optional Services.” Optional Services also include the use of specialized techniques instead of standard procedures. For example: a crown where a filling would restore the tooth, a precision denture where a standard denture could be used, or an inlay instead of a restoration. If you receive Optional Services, your Benefits will be based on the lower cost of the customary service or standard practice instead of the higher cost of the Optional Service. You will be responsible for the difference between the higher cost of the Optional Service and the lower cost of the customary service or standard practice.

Exclusions – The Insurance Company does not pay Benefits for:

1.Services for injuries or conditions which are compensable under workers’ compensation or employers’ liability laws; services which are provided to the Enrollee by any federal or state government agency or are provided without cost to the Enrollee by any municipality, county or other political subdivision except as such exclusion may be prohibited by law.

2.Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to cleft palate, maxillary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration) of the teeth, and andontia (congenitally missing teeth), except those services provided to newborn children for congenital defect or birth abnormalities or services that may be provided under Orthodontic Benefits.

3.Services for restoring tooth structure lost from wear, erosion, or abrasion, for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion, or for stabilizing the teeth. Such services include, but are not limited to: equilibration, periodontal splinting, occlusal adjustment.

4.Any single procedure started prior to the date the person became covered for such services under this program.

5.Prescribed drugs, medication or analgesia

6.Experimental procedures

7.Charges by any hospital or other surgical or treatment facility and any additional fees charged by the Dentist for treatment in any such facility.

8.Charges for anesthesia, other than by a licensed Dentist for administering general anesthesia in connection with covered oral surgery services.

9.Extra oral grafts (grafting of tissues from outside the mouth to oral tissues).

10.Services with respect to any disturbance of the temporomandibular joint (jaw joint).

11.Services performed by any person other than a Dentist or auxiliary personnel legally authorized to perform services under the direct supervision of a Dentist.

12.Replacement of teeth extracted prior to the member’s effective date are not covered benefits.

13.Replacement of an Crown, Jacket, Cast Restoration, Bridge or Denture that the patient received in the previous five (5) years.

See the limitation and exclusion disclosures for additional details.

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California Dental Insurance $1500 Max Platinum Plan Underwritten by Delta Dental Insurance Company, 5.0 out of 5 based on 1 rating
Posted on 04/26/11 6:05 AM | by California Dental | in California Dental Insurance | No Comments »

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