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  ELITE PREFERRED 510 (EP 510) PPO
  Overview
  Schedule of Benefits
  FAQs
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  Vision Option
  Plan Overview
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  MyCompBenefits
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Elite Preferred 510 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
  • X-Rays
    •
  • Space Maintainers
  • Sealants

    •      		 100% 100%
    Type II - Basic Services Reimbursement
      In
    Network    		 Out of Network*
  • Simple Restorative
  • Periodontics
  • Emergency Palliative Treatment
  • Non-Surgical Tooth Extraction
  • Endodontics
  • Surgical Tooth Extraction
  • Oral Surgery

    •       		80%

    80%

    Type III - Major Services Reimbursement
    In
    Network    		 Out of Network*
  • Major Restorative (crowns/inlays/onlays)
  • Bridge, Denture Repair
  • Prosthetics (bridges and dentures)
     
    		•  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

    $1500
     

    		 $1500

    Deductible per person; maximum 3 per family
       



        Type I

    		None
         		 None

        Type II, III
       

    $25 

    		$25 


    Exclusions
    and Limitations

    		 *Coverage based on usual, customary, and reasonable fees.

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

    Certain exclusions and limitations apply.
     

    This schedule shows only a few of the covered procedures. 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.