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CS-150 DHMO Overview
The DHMO plan provides a wide variety of benefits through your
participating provider. At the time of services, you pay the dentist for
any applicable copayments according to your schedule of benefits. The plan
features:
 | No claims to file |
| No hidden costs |
| No maximums |
| No waiting periods
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Frequently Asked Questions
How many times a year can I visit my dentist?
You are encouraged to visit your dentist regularly. With your CompBenefits
dental plan, you are not limited to a specific number of visits per year.
How can I get more information?
You can contact Member Services at 1-800-342-5209, M-F, 8am-6pm EST.
Member Services can assist you with changing your provider, information
about your plan, or obtaining emergency services. Locate us on the web at
www.compbenefits.com to find the provider near you.
Is there any maximum coverage limitation?
There are no limitations on benefits.
How do I pay for services?
If your visit is for covered preventive care, like a routine exam,
cleaning, or x-ray, there is no charge for the procedure. The dentist is
prepaid by the CompBenefits program. For other procedures, a small
copayment may be required. See your Schedule of Benefits for amounts. You
pay copayments directly to the dentist.
What if I need a Specialty Dentist?
Should you need a Specialty Dentist (i.e., Endodontist, Orthodontist, Oral
Surgeon, Periodontist, Prosthodontist, Pediatric Dentist), you may be
referred by your Participating General Dentist, or you may refer yourself
to any Participating Specialty Dentist. Copayment amounts are applicable
when treatment is performed by selected Participating General Dentist or
by Participating Specialty Dentists. Benefits for procedures not listed on
the schedule, that are performed by a Participating Specialty Dentist, are
available at the Participating Specialty Dentist's usual and customary fee
less 25%.
How do I make appointments?
Making an appointment is easy. Simply call the dental office you have
selected, on or after the date you receive your certificate of coverage,
and you can schedule an appointment. Your enrollment with that dental
office will already be on hand, confirming that you are eligible for
treatment.
What if I go to a non-participating dentist?
You will not be eligible for benefits. You must receive treatment from the
Participating General Dentist you have selected.
Monthly rates for: City of West Palm Beach
Effective date: January 1, 2004
| Employee: |
$0.00 |
| Employee + 1: |
$5.84 |
| Employee + Family: |
$16.60 |
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Rates show employee comtribution only. |
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| Type I - Preventive Services |
Patient Pays |
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Office Visit
Initial Exam
X-Rays (Bitewings)
Semi-Annual Cleaning
Sealant - per tooth
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$5.00
No charge
No charge
No charge
$10.00
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| Type II - Basic Services |
Patient Pays |
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One surface silver filling
Two surface white filling, anterior
Single tooth extraction
Surgical removal of erupted tooth
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No charge
$40.00
No charge
$40.00
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| Type III - Major Services |
Patient Pays* |
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Porcelain crown (high noble)
Porcelain bridge
One surface inlay
Molar root canal therapy
Complete upper dentures
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$280.00
$280.00
$95.00
$250.00
$300.00
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| Type IV � Orthodontics |
Patient Pays* |
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Treatment for children to age 19
Evaluation
Treatment Planning
Orthodontic Treatment
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$35.00
$250.00
$1800.00
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* Some services require additional lab fees.
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Calendar Year Deductible |
None |
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Annual Maximum Benefit |
None |
Pre-Existing Condition Exclusion
Exclusions and Limitations
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No pre-existing condition exclusion applies
Certain exclusions and limitations apply
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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.
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