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(Only Available in California , Nevada
and Texas)
This indemnity plan offers total
freedom of choice in dental providers. The Select Dental Plan provides the
individual with excellent coverage and minimal waiting periods.
Click here for complete brochure! There is no age
limit! People over age 65 are welcome! Up to $1,000 in benefits paid
per insured, per benefit year! Competitive Monthly Premium
Rates - California, Nevada
and TexasYour Deductible |
Plan Pays* |
Services Covered |
|---|---|---|
$10 per visit |
80% |
Type 1 - Diagnostic and
Preventive Treatment |
$50 |
80% |
Type 2 - Basic Procedures (3
month waiting period) |
$50 |
50% |
Type 3 - Major Procedures (12
month waiting period) |
| Diagnostic x-rays and teeth cleanings as follows: Full mouth
x-rays once every 36 months; bitewing x-rays and prophylaxis once every 6
months; and topical fluoride treatment (dependent children under age 14)
once every six months. Benefits are based upon reasonable and
customary charges for the areas where expenses are incurred. * There is a 3-month waiting period for Type 2 Basic Procedures from the insured person's effective date of coverage. ** There is a 12-month waiting period for Type 3 Major Procedures from the insured person's effective date of coverage. *** There is a 24-month waiting period for replacement of Prosthetic Appliances. (crowns, bridges, dentures.) |
||
*Benefits are based on reasonable and customary charges for the areas where expenses are incurred.
effective March 1, 2003
Zip Code |
Member Only |
Member + 1 |
Member + 2 or More |
|---|---|---|---|
ALL OTHER CALIFORNIA ZIP CODES |
$40.00 |
$80.00 |
$120.00 |
| 900, 901, 902, 903, 904, 905, 906, 907, 908, 910, 911, 912, 914, 915, 916 |
NOT AVAILABLE | ||
effective November 1, 2002
Zip Code |
Member Only |
Member + 1 |
Member + 2 or More |
|---|---|---|---|
889 |
$31.00 |
$61.00 |
$95.00 |
ALL OTHER NEVADA ZIP CODES |
$32.00 |
$63.00 |
$96.00 |
effective March 1, 2003
Area |
Zip Code |
Member Only |
Member + 1 |
Member + 2 or More |
|---|---|---|---|---|
1 |
754-759, 768, 779-781, 786, 788, 790-796, 798-799 |
$20.00 |
$42.00 |
$57.00 |
2 |
753, 761-767, 769, 773, 776-777, 782-785, 797 |
$21.00 |
$44.00 |
$60.00 |
| 3 | 750-751, 760, 774, 778, 787, 789 | $23.00 | $48.00 | $65.00 |
| 4 | 752, 770-772, 775 | $26.00 | $52.00 | $72.00 |
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