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Elite Preferred 710 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

How can I reduce Out-Of-Pocket Expenses?

By using one of our PPO Providers you have the benefit of reduced out-of-pocket expenses. You also get additional peace of mind knowing that our providers go through an extensive credentialing process.

How does the plan work?

  1. The PPO plan allows you to seek treatment from any licensed dentist.
  2. Once services are performed, you or your dentist must file a claim form in order to receive reimbursement.
  3. Your claim will be paid based on your group's schedule of benefits. Benefits will be payable after your deductible and coinsurance (if applicable) are satisfied. Your plan also has an annual limit on benefits available.

The dentist may agree to file your insurance claim for you. However, if he/she does not, you may be required to pay the entire bill at the time services are rendered and submit a claim to CompBenefits for reimbursement.

Where should I send my claims?

Claim forms can be obtained from your Group Benefits Administrator or CompBenefits Member Services and should be sent to:

CompBenefits Claims
PO Box 8236
Chicago, IL 60680-8236

Your provider may also file your claims electronically.

What is a predetermination?

The purpose of submitting a predetermination is to help you understand how your benefits will be paid for your proposed treatment plan.

When is a predetermination needed?

If a planned treatment is going to cost over $200, you should ask the dentist to file for predetermination of benefits before services begin.

How can I get further questions answered?

You may contact CompBenefits with any questions or concerns at
1-800-342-5209, M-F 8 am � 6 pm EST. Locate us on the web at www.compbenefits.com.
 

Monthly rates for: City of West Palm Beach
Effective date: January 1, 2004

Employee: $22.30
Employee + One: $52.65
Employee + Family: $103.29

Rates show employee comtribution only.

Type I - Diagnostic & Preventive Services Reimbursement

  • Oral Exam
  • Prophylaxis
  • Topical Fluoride
  • X-Rays
  • Sealants
  • Space Maintainers
     
    		•  In
    Network

    100%

    		 Out of
    Network*

    100%
    Type II - Basic Services Reimbursement

  • Simple Restorative
  • Periodontics
  • Emergency Palliative Treatment
  • Tooth Extraction
  • Endodontics
     
    		•  In
    Network

    80%

    		 Out of
    Network*

    80%

     
    Type III - Major Services Reimbursement

    (12 month waiting period)
  • Major Restorative (crowns/inlays/onlays)
  • Bridge, Denture Repair
  • Prosthetics (bridges and dentures)
     
    		•  In
    Network

    50%

    		 Out of
    Network*

    50%

     
         
    MAXIMUM BENEFITS In
    Network    		 Out of
    Network
    Lifetime
         Type I, II, III    		 Unlimited Unlimited
    Calendar Year
         Type I, II, III    		 $1,000 $1,000
    Deductible $150 per family maximum
         Type I
         Type II, III    		 Waived
    $50    		 Waived
    $50
         

    Exclusions and Limitations

    *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.

    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.