Dental 2019 - GroupAccess

Dental Plans for up to 50 Employees

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	Essential Dental for Business	Total Dental for Business	Premier Dental for Business
Materials	View Benefit Summary View Benefit Booklet	View Benefit Summary View Benefit Booklet	View Benefit Summary View Benefit Booklet
Monthly Rates	Self: $16 Self +1: $32 Family: $55	Self: $23 Self +1: $46 Family: $79	Self: $32 Self +1: $66 Family: $123
Calendar Year Deductible	$50 per person; $150 per family	$50 per person; $150 per family	IN-NETWORK $25 per person; $75 per family (does not apply to orthodontic services)	OUT-OF-NETWORK Not Covered
Calendar Year Maximum Benefits	$1,000 per person	$1,000 per person	IN-NETWORK $1,500 per person	OUT-OF-NETWORK Not Covered
Diagnostic and Preventive Services Dental exams and x-rays Routine cleanings Flouride treatment for children through age 18	Plan pays 100%	Plan pays 100%	IN-NETWORK Plan pays 100%	OUT-OF-NETWORK Not Covered
Basic Services Fillings Simple tooth extractions Root canal (non-surgical) Emergency treatment for pain Repairs to crowns, inlays, onlays, fixed partial and removable dentures	Plan pays 80% after deductible*	Plan pays 80% after deductible	Plan pays 100% after deductible	Not Covered
Major Services Oral surgery General anesthesia Periodontic exams Removal of diseased gum tissue and bone	Plan pays 60% after deductible**	Plan pays 75% after deductible	Plan pays 75% after deductible	Not Covered
Additional Major Services Crowns, inlays, onlays, bridges and dentures	Not Covered	Plan pays 50% after deductible	Plan pays 75% after deductible	Not Covered
Orthodontic Services** Coverage for dependent children up to age 19	Not Covered	Not Covered	IN-NETWORK Plan pays 50% after orthodontic deductible	OUT-OF-NETWORK Plan pays 40% after orthodontic deductible
Calendar Year Orthodontic Deductible¹	Not Covered	Not Covered	$150 per person	$150 per person
Lifetime Orthodontic Maximum Benefits²	Not Covered	Not Covered	$1,500 per person	$1,250 per person

*180-day waiting period (Essential Dental plan only)
**365-day waiting period

Late enrollees on Total Dental for Business and Premier Dental for Business are subject to a 365-day waiting period on Major and Additional Major Services. Orthodontic Services 365-day waiting period is applicable to all enrollees on Premier Dental for Business.

¹Amounts applied towards the in-network calendar year orthodontic deductible count towards your out-of-network calendar year orthodontic deductible; amounts applied towards your out-of-network calendar year orthodontic deductible count towards your in-network calendar year orthodontic deductible.

²Amounts applied towards the in-network lifetime orthodontic maximum benefits count towards your out-of-network lifetime orthodontic maximum benefits; amounts applied towards your out-of-network lifetime orthodontic maximum benefits count towards your in-network lifetime orthodontic maximum benefits.

+ Rates and benefits are subject to change.

Dental 2019 - GroupAccess - Alabama

Essential Dental for Business

Total Dental for Business

Premier Dental for Business

Essential Dental
for Business

Total Dental
for Business

Premier Dental
for Business