• Free choice of dentist
• Benefits increase after the first and second years
• In- and Out-of-Network benefits
• $100 lifetime deductible on ortho
• Benefits up to $1200 per calendar year
• Ortho benefits for dependents included at no extra charge
• 6 month waiting period basic
• 12 month waiting period for oral surgery, major and ortho
  

Dental Plan Exclusions & Limitations

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 Carrier does not pay Benefits for:

1. Services for injuries or conditions which are compsenable 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.

Online Enrollment

You may purchase the Dental for Everyone plan in two ways:

1. Buy it right now by selecting our Indemnity Plan or our DPO Plan. After clicking this link, you will be prompted to enter your zip code. This will begin the enrollment process.

2. Download an application from our Forms section.

• No deductible
• No waiting period
• A vision examination each 12 months
• One set of frames each 24 months
• Your choice of eye care providers
• One pair of standard lenses or contact lenses each 12 months
• In- and Out-of-Network benefits
• Laser eye surgery benefits through the Laser Vision Network of America (LVNA)
• Network Providers include Private Practice Doctors and Retail Chain Providers

In-Network Benefits

• Lenses: If prescribed, a pair of single vision or standard lined multi-focal lenses every 12 months with only a $20.00 co-pay

• In lieu of lenses and a frame, ($20.00 co-payment applies) you may select from Spectera’s wide variety of covered contact lenses when obtained from a network provider. A $105.00 credit will be applied toward any fitting fees, and the purchase of non-covered contact lenses once every 12 months.

• There is a $210 allowance for “necessary” contacts. (When your vision cannot be corrected to better than 70/20 with standard lenses.)

• One pair of frames (each 24 months) from a wide selection of high quality men’s, women’s and children’s frames and a set of lined single/bifocal/trifocal lenses (each 12 months) for a $20.00 co-pay. If you select a frame from outside the covered selection, you will pay the wholesale cost minus a $50.00 frame allowance. In the case of retail chain provider locations, due to their pricing structures, the participant will receive a minimum $130 frame allowance for frames purchased at retail chain providers. Please consult with the specific provider in your area.

• Patient Options: Should you select items not covered by the program, such as progressive lenses, tints, coatings, ect., there will be an additional charge. These charges, however, are below usual retail costs. (Standard Scratch coating is covered in full at no cost to the insured.)

• To locate an In-Network Provider call 800-839-3242 or use Spectera’s web site www.spectera.com (Click on provider locator, enter zip code, enter social security number or [any 9 digit number], enter birth date and click submit.)

Out-of-Network Benefits
(Out-of-Network – Reimbursement up to the following amounts once in a 12-month period – frames once in a 24-month period)