AlwaysDental PORTFOLIO
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| PPO Plans offer flexibility and cost savings for employers.
Passive – Coinsurance levels are the same for in- and
out-of-network plan designs
Active – Coinsurance levels are different for in- and
out-of-network plan designs; In-network coinsurance levels are set to encourage Members
to visit in-network providers by offering richer coinsurance percentages than out-of-network;
Not available in all states
Immediate – No Waiting Periods! Varying coinsurance levels
by year; The coinsurance percentage increases each year then levels off in year three
Preventive/Basic – Coverage for Preventive and Basic services
only
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| EPO – Pays a benefit from the PPO reimbursement schedule for
in-network provider services; No out-of-network benefits |
| MAC – Covered services are paid from the PPO reimbursement
schedule for both in- and out-of-net work services |
| Scheduled Plans – Benefits are reimbursed from the flat fee
schedule only, whether services are provided by a network provider or not |
| Indemnity – Fee-for-service plans without networks |
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| Individual Dental Plans also available |
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FEATURES AND OPTIONS
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Deductible Options
• $25 •
$50 • $75 •
$100 Lifetime (Takeover Credit available) |
| Waiting Periods
12 month waiting period standard for major and orthodontia services (waived subject to takeover
benefits)
No waiting period and other waiting period options also available |
Endodontics and Periodontics Services
• Class B (Basic Services) • Class C
(Major Services) |
| Rate Guarantee Options |
| 12 month rate guarantee standard; 24 month available on special plans |
 Other Plan Features
Endosteal implant available in lieu of conventional fixed 3-unit bridge (Standard Benefit)
Additional cleaning for pregnant women in their 2nd or 3rd trimesters (Standard Benefit)
Members 40+ years of age who demonstrate risk factors for oral cancer or suspicious lesions
are entitled to one adjunctive, prediagnostic test per year (Standard Benefit)
Members diagnosed as diabetic are eligible for up to 2 extra cleanings every twelve
months (Optional Benefit) |
| OPTIONAL BENEFIT RIDERS
Cosmetic Benefit Rider (50+ enrolled)
Fully Insured Hearing Benefit Rider (10+ enrolled)
Carryover Benefit Rider – If an Insured submits Qualifying Claims for Covered Expenses
and receives benefits that are less than the group’s Threshold amount within one benefit
year, the Insured will be credited a Carryover Benefit.* (Takeover credit available) |
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* See Carryover Benefit flyer for more details, Limitations and Exclusions
