DHMO Questions and Answers

Your rates are listed below.

Panel Dental Plan
	10 Month		11 Month		12 Month

	High	Standard	High	Standard	High	Standard
Employee	8.21	5.30	6.72	4.34	6.16	3.98
Employee & Family	20.73	13.37	16.96	10.94	15.55	10.03
Family Only	12.52	N/A	10.24	N/A	9.39	N/A

Exclusions/Limitations:

No service or any dentist other than a Participating General Dentist or Participating Specialist will be covered, except out-of-area emergency care. Emergency care means treatment due to injury, accident, or severe pain requiring the services of a dentist which occurs under the circumstances where it is neither medically nor physically possible for the Member to be treated by any Company Participating General Dentist or Participating Specialist. An acute periodontal abscess and an acute periapical abscess which occur under circumstances where it is not possible for the Member to be treated by any Company Participating General Dentist or Participating Specialist are examples where emergency benefits would be applicable. When more than one hundred (100) miles from the nearest available Company Dental Facility, the Member may obtain reimbursement for expense for Emergency Care rendered by any licensed dentist, less applicable Company co-payments, up to one hundred dollars ($100), per Member per year, upon presentation of an itemized statement of emergency services from the dental office. Company must be notified of such treatment within ninety (90) says of its receipt.

Whenever any contributions or co-payments are delinquent, members will not be entitled to receive benefits, transfer dental facilities, or enjoy any of the other privileges of a member in good standing.

CompBenefits does not provide coverage for the following services:

	Cost of hospitalization and pharmaceuticals, drugs or medications
	Services which, in the opinion of the Participating General Dentist or Participating Specialist, are not necessary treatment to establish and/or maintain the member's oral health.
	Any service that is not consistent with the normal and/or usual services provided by the Participating General Dentist or Participating Specialist or which, in the opinion of the Participating General Dentist or Participating Specialist, would endanger the health of the member.
	Any service or procedure which the Participating General Dentist or Participating Specialist is unable to perform because of the general health or physical limitations of the member.
	Any dental treatment started prior to the member's effective date of eligibility for benefits.
	Services for injuries and conditions which are paid or payable under Worker's Compensation or Employer's Liability laws.
	Treatment for cysts, neoplasms and malignancies.
	General anesthesia.

Employee-Paid Benefits:

You may cover yourself by selecting the "Employee Only" benefit.
You may cover yourself and your eligible dependent(s) by selecting the "Employee and Family" benefit.
You may select "Family Only" if your coverage is included in a FlexPlan Option.
Indicate your facility choice in the space provided for each family member under the Employee-Paid Benefits section of the Web enrollment form.

If you choose one of the CompBenefits Dental Plans and desire dependent dental coverage, your dependents must also be covered by the same level of coverage under your CompBenefits plan. You may choose a different dentist for each family member on your Web enrollment form, the CompBenefits Web site or by calling CompBenefits Member Services Department at 1-800-432- 3376 during the plan year.

Note:
This product description does not constitute an insurance certificate or policy. The information provided is intended only to assist in the selection of benefits. Final determination of benefits, exact terms and exclusion of coverage for each benefit plan are contained in certificates of insurance issued by the participating insurance companies.

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