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 Indemnity Plan
You Choose the Dentist

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

Plan Features
• $100 Life time Deductible (does not apply to type I)
• Up to $1000 annual benefit
• Free choice of dentist
• No age limits
• 6 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

Plan Pays
 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.
50%
 Type 2 - Basic Procedures (6 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.

Reimbursement method UCR

Monthly Premium

Click here to locate your area...

Area
Member
Plus One
Family
1
$39.07
$71.44
$98.04
2
$42.83
$78.75
$114.68
3
$46.99
$86.87
$126.75
4
$51.61
$95.87
$140.14
5
$56.72
$115.31
$155.01
6
$62.41
$116.95
$171.51
7
$68.74
$129.28
$189.81

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