Dental Facts
“Most dental disease can be avoided through preventive care and good oral hygiene.”
The American Dental Association

“Every year one of ten people experiences a restricted activity day or lost work day due to dental disease.”
National Center for Health Statistics

“Tooth decay and other dental diseases affect nearly 90% of the population.”
American Institute of Preventive Medicine

The continuing rise in the cost of dental care has made dental insurance an important consideration for today’s American families. Now you and/or your family are eligible for this new Voluntary Dental Plan.

And you select
your own dentist!
Choice Dental DPO Plan
In or Out of Network Benefits

Features | Benefits | Premium | How Do I Enroll? | Exclusions & Limitations

Click here to locate DPO Providers...

Plan Features
• $100 Life time Deductible (does not apply to type I)
• Up to $1000 annual benefit
• Free choice of dentist
• No age limits
• 3 month waiting period for basic procedures
• 12 month waiting period for major procedures
• Keep your dental plan regardless of your age
• No questions about your past dental history

Benefits Association
As a member of Benefits Association you receive the following Benefits and Services:
• PreScrip - Discount prescription program
• Budget - Car rental discounts
• Vitamins - Nutritional supplements
• United Van Lines - Discount moving service
• PowerNet - Discount long distance rates

Dental Insurance Benefits

Services Covered

100 %

 Type 1 - Diagnostic and Preventive Treatment
Diagnostic: Routine periodic examinations once in a 6 month period.
Preventive: Dental prophylaxis (teeth cleaning and scaling) once in a 6 month period (including application of topical fluoride for dependent children only).
Radiography: Bitewing x-rays once in a 12 month period. Full mouth x-rays one in a 36 month period.
80%
 Type 2 - Basic Procedures (3 month waiting period)
Restorative: Amalgam, synthetic porcelain or plastic fillings.
Other: Space maintainers, recementation of crowns.
50%
 Type 3 - Major Procedures (12 month waiting period)
Endodontics: Pulpal therapy and root canals.
Periodontics: Treatment of diseases of the gums.
Oral Surgery: Extractions and other oral surgery, including pre and post-operative care.
Prosthetics: Gold restorations, crowns, bridges, partials and complete dentures.
Other: Pontics, repair of crowns and bridges, repair of full and partial dentures.

In or out of network benefits, paid on the negotiated provider fee schedule.

Monthly Premium

Click here to locate your area...

Area
Member
Plus One
Family
1
$32.05
$57.75
$83.45
2
$35.01
$63.52
$92.01
3
$38.31
$69.95
$101.60
4
$41.97
$77.09
$112.21
5
$46.04
$85.04
$124.05
6
$50.57
$93.85
$137.14
7
$55.58
$103.63
$151.67

Includes: $4.00 Billing Fee, $1.00 Association Dues

How Do I enroll?

1. Select the insurance package that fits your needs (Example: “Family”).

2. Complete the Dental Enrollment Form & Benefits Association Enrollment Form

3. Select mode of payment.

4. Enclose a voided check. DO NOT send in first months premium.

5. Questions concerning benefits or enrolling?Call PlanChoice: 800-466-5182

All correspondence and enrollment forms should be forwarded to:
PlanChoice, 3010 Taylor Springs Drive, Louisville, KY 40220
Applications must be received in the home office on or before the 20th of each month for a 1st of the following month effective date.

Or click here to buy this plan online...

The preceding information is a brief description of coverage. See policy (MS-POL-UCR) for complete details.

 

 

 

 
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  502-459-2444 or 800-466-5182 • 3010 Taylor Springs Drive, Louisville, KY 40220