SouthEast Personnel Leasing Inc.
 
DHMO Dental Option (Florida Only)
  CS250 DHMO Overview
  CS250 DHMO Schedule

  CS250 DHMO FAQs

  Search for Providers
DHMO Dental Option (GA Only)
  HS210 DHMO Overview
  HS210 DHMO Schedule

  HS210 DHMO FAQs

  Search for Providers
PPO Dental Option
  Elite Prefered 700 Overview
  Elite Prefered 700 Schedule
  Elite Prefered 700 FAQs

  Search for Providers
  Claim Form

Vision Option
  Plan Overview
  Certificate of Benefits
  LASIK Benefits
 
Dental/Vision Members
  MyCompBenefits
 
  Contact Information


Elite Preferred 700 Dental PPO Overview

The PPO plan offers a variety of benefits with set reimbursement amounts. You pay the provider for services at the time of your appointment. Claim payments are then made to you or your provider. The plan features:

bulletFreedom to choose any dentist
bulletQuick claims turnaround
bulletNational coverage


Type I - Diagnostic & Preventive Services Reimbursement
In
Network		 Out of Network*
  • Oral Exam
  • Prophylaxis
  • Topical Fluoride
     
    		•  100% 100%
    Type II - Basic Services Reimbursement
      In
    Network    		 Out of Network*
  • Simple Restorative
  • X-Rays
  • Sealants
  • Space Maintainers
     
    		•  80%

    80%

    Type III - Major Services Reimbursement
    In
    Network    		 Out of Network*
  • Periodontics
  • Emergency Palliative Treatment
  • Tooth Extraction
  • Endodontics
  • Major Restorative
  • Bridge, Denture Repair
  • Prosthetics
     
    		•  50% 50%

         		    
    MAXIMUM BENEFITS    
      In
    Network    		 Out of Network*
    Lifetime    
        Type I, II, III Unlimited Unlimited

    Calendar Year Maximum (per person)    
        Type I, II, III $1000 $1000

    Deductible - $50 per person; max 3 per family; waived for Type I    
        Type II, III $50 $50


    Exclusions
    and Limitations

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

    Certain exclusions and limitations apply.
     

    This schedule shows only a few of the covered procedures. Please see your Benefit Administrator for a complete schedule. This schedule is intended for comparison purposes only. The benefits for each plan will be determined by the contract. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage.