Renaissance Dental Insurance Plan III

Renaissance Dental Insurance Plan III - Individual Plan

Dental Insurance

$44.08 Month

That's only $528.96 per person, per year.

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Program Summary

Renaissance Dental is a leader in the dental insurance industry. Renaissance Dental provides access to more than 300,000 dental locations throughout the country. This plan offers the freedom to go to any licensed dentist, however, you may save on out-of-pocket costs by going to an in-network dentist.

Maximum Payment for Covered Services

  • 100% coverage for Diagnostic & Preventive Services when you see an in-network dentist
  • No waiting periods for Diagnostic & Preventive Services
  • $50 deductible waived for Diagnostic & Preventive Services
  • Coverage for Implants and Crowns
Benefit In-network Out-of-network
Individual annual deductible
(waived for preventive services)
$50 per person $50 per person
Family annual deductible
(waived for preventive services)
$150 per family $150 per family
Annual Benefit Maximum $1,000 per person $1,000 per person

Plan Highlights

  • Benefits for cleanings and oral examinations are payable twice per benefit year.
  • A third cleanings is payable per benefit year for individuals with a documented history of periodontal disease and a fourth cleanings is payable for two consecutive calendar years following periodontal surgery.
  • Benefits for bitewing X-rays are payable once per benefit year.
  • Benefits for full mouth X-rays (which include bitewing X-rays) or a panorex are payable once in any five consecutive years.
  • Fluoride treatments are payable twice per benefit year for age 13 and under.
  • Space maintainers are payable once per area in a lifetime for age 13 and under.
  • Crowns, onlays, dentures, bridges, and substructures are limited to once in a seven-year period.
  • Benefits for Temporomandibular Disorders (TMD) are limited to those services normally provided by a dentist to relieve oral symptoms associated with malfunctioning of the temporomandibular joint. This does not include services that would normally be provided under medical care.
  • Composite resin (white) restorations and porcelain crowns are Covered Services on posterior teeth.
  • Orthodontics and related services are not Covered Services.

Maximum Payment for Covered Services:

  • $1000 per person total per Benefit Year on Class I, Class II and Class III Benefits collectively
  • $300 per person total per Lifetime for TMD treatment

Deductibles For Covered Services:

  • $50 per person per benefit year
  • $150 annual deductible for families.
  • Deductible does not apply to diagnostic, preventive or emergency palliative treatments.
  • Waiting Period – 6 months following effective date of insurance: X-rays (not including bitewing), periodontal prophylaxes, denture repair, rebase, relining, minor restorative.
  • Waiting Period – 12 months following effective date of insurance: Oral surgery, periodontics, endodontics, crown and cast restorations, prosthodontics and TMD treatment

Dental Benefit Highlights

Dental Services

In-Network Dentist Out-of-Network Dentist Waiting Periods
Diagnostic & Preventive Services
Diagnostic and preventive services*—Includes exams and cleanings twice per year, bitewing X-rays, and fluoride treatments to age 14 In-Network Dentist: 100% Out-of-Network Dentist: 80% Waiting Periods None
Emergency palliative treatment* In-Network Dentist: 100% Out-of-Network Dentist: 80% Waiting Periods None
Radiographs/diagnostic imaging*—X-rays In-Network Dentist: 80% Out-of-Network Dentist: 60% Waiting Periods None
Minor Services
Periodontal cleaning—Following active periodontal therapy In-Network Dentist: 80% Out-of-Network Dentist: 60% Waiting Periods None
Denture and bridge repairs and relines In-Network Dentist: 80% Out-of-Network Dentist: 60% Waiting Periods None
Minor restorative services—Silver and white fillings In-Network Dentist: 80% Out-of-Network Dentist: 60% Waiting Periods 6 Months
Major Services
Oral surgery services—Extractions and dental surgery, including local anesthesia, suturing, and post-operative care In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Endodontic services—Root canals In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Periodontic services—Treatment for diseases of the gums and supporting structures of the teeth In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Prosthodontic services—Bridges, dentures and implants In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Crown and cast restorations—Metal and porcelain crowns In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
TMD treatment—Treatment for jaw and facial joint disorders In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Maximums and Deductible
Contract year maximum In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
TMD lifetime maximum In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months
Deductible (per contract year) *Deductible waived for these services In-Network Dentist: 50% Out-of-Network Dentist: 50% Waiting Periods 12 Months

NOTES: The enclosed summaries are samples of benefits. Policies have exclusions and limitations that may limit coverage. Renaissance Dental PPO Basic Plan may not be available in all states. For complete coverage details, please refer to your policy, INVD-100A-(state abbreviation, if applicable
Disclosures

Plans underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN, and in New York by Renaissance Life & Health Insurance Company of New York, New York, NY.

Note: Some procedures in the categories may be payable at a different benefit level than indicated. The submission of a pre-determination will provide an estimate of patient out-of-pocket expenses.

The enclosed summaries are samples of benefits. Policies have exclusions and limitations that may limit coverage. For complete coverage details, please refer to your policy, INVD-100A-ID.

Exclusions: Cosmetic surgery or dentistry for aesthetic reasons (except reconstructive surgery for children because of congenital disease or anomaly); general anesthesia and/or intravenous sedation; treatment by anyone other than a licensed dentist or dental hygienist; veneers, sealants, prosthodontics (implants), prefabricated crowns as final restoration on permanent teeth and paste-type root canal fillings on permanent teeth; appliances, procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Policy and/or Summary of Dental Plan Benefits.

Limitations: Coverage for services may be limited based on the age of the person receiving services; coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years); coverage for temporomandibular disorders (TMD) is limited.

The policy has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with the policy provisions. Coverage may be terminated for reasons stated in the policy. Coverage ceases upon termination of the policy. Products and services referred to in this brochure may not be available in all states or jurisdictions.

Underwritten by Renaissance Life & Health Insurance Company of America, PO Box 1596, Indianapolis, IN 46206

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