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Elite Preferred 505 Schedule

bulletOVERVIEW
bulletSUMMARY OF BENEFITS
bulletMAXIMUM BENEFITS
bulletPREDETERMINATION
bulletEXCLUSIONS
bulletMAJOR RESTORATIVE LIMITATIONS
 

 

OVERVIEW

Because we specialize in dental plans, we can bring you benefits and service that other companies can't match!

Quick Claims Turnaround

CompBenefits' state of the art claims center provides fast reimbursement of your claims.

Access to Information

Our toll-free customer service number at 1-800-342-5209 has Member Services Representatives who can provide the answers you need quickly and thoroughly.

Total Freedom of Choice

The plan provides you with total freedom of choice by allowing you to use any licensed dentist for treatment. The plan reimburses a percentage of eligible expenses based on the plan you have chosen.

Any way you add it up, CompBenefits really is the benefits company of choice!

A complete description of the coverage, including limitations on certain procedures, is found in the Schedule of Benefits and Certificate of Group Dental Insurance.

 

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SUMMARY OF BENEFITS

Partial Listing of In-Network Out-of-Network
Covered Services Reimbursements Reimbursements
 
Type I Diagnostic & Preventive 100% 100%
 
  • Oral Examination (once per six months)
  • Prophylaxis (cleaning, once per six months)
  • Topical Fluoride (children under 16,once per 12 months
  • X-Rays (limitations may apply)
  • Sealants (once per 3 years for children under age 16, for non carious molars only)
    		•
     
    Type II Basic Services 80% 80%
     
  • Simple Restorative (amalgam, synthetic, or composite fillings)
  • Space Maintainers (for children under age 16)
  • Non-surgical Tooth Extractions
  • Non-surgical Periodontics
    		•
     
    Type III Major Services 50% 50%
     
  • Major Restorative (crowns/inlays/onlays)
  • Bridge, Denture Repair
  • Prosthetics (bridges and dentures)
  • Emergency Palliative Treatment
  • Endodontics (root canals)
  • Surgical Tooth Extractions
  • Surgical Periodontics
    		•
     
    Type IV Orthodontics - excluded

     

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    MAXIMUM BENEFITS

    Insured Individual and Dependents

      In-Network Out-of-Network
      Reimbursements Reimbursements
     
    Lifetime
    Type I, II, III Unlimited Unlimited
     
    Calendar Year
    Type I, II, III $1,000 $1,000
     
    Deductible***
    Type I $0 $0
    Type II, III $50 $50
     

    *Coverage based on contracted fees for the Preferred Provider Network.

    **Time served on the employer's immediately preceding group dental plan may be credited towards this plan's waiting periods, subject to Underwriting approval.

    ***Maximum of 3 per family.

     

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    PREDETERMINATION

    If Covered Dental Expenses for a procedure are expected to be more than $300 it is recommended that you send a Dental Treatment Plan in prior to beginning treatment, send preauthorization to:

    CompBenefits
    P.O. Box 8236
    Chicago, IL 60680�8236

    You and/or your dentist will be notified of the benefits payable based upon the Dental Treatment Plan.

    This information contains a brief description of the plan. A complete description of the coverage, including limitations on certain procedures is found in the Schedule of Benefits and Certificate of Group Dental Insurance.

     

     

     

     

     

     

    To submit comments or questions, please visit our Contact Center.

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