| Company |
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Security
Life Insurance Company of America |
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Baltimore
Life Insurance Company |
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Baltimore
Life Insurance Company |
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| Plan
Name |
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"DVPC"
Dental Vision Prescription Chiropractic |
|
Private
Choice Dental & Vision
[no prescription or chiropractic] |
|
Plan
A (Dental & Vision)
[no prescription or chiropractic] |
|
Plan
C (Dental & Vision)
[no prescription or chiropractic] |
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|
Exclusions
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NONE
- everything included |
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VIEW
EXCLUSIONS |
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VIEW
EXCLUSIONS |
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VIEW
EXCLUSIONS |
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| Plan
Type |
|
Discount
- month to month |
|
Insurance
- open ended policy |
|
Insurance
- open ended policy |
|
Insurance
- open ended policy |
|
| Family
Premium per month* |
|
|
|
$92.60 |
|
$108.00 |
|
$78.00 |
|
| Maximum
Benefit |
|
NO
LIMITS |
|
$1,500
Per Person Per Calendar Year (combined for all services) |
|
$1,250
Per Person Per Calendar Year (combined for all services) |
|
$1,000
Per Person Per Calendar Year (combined for all services) |
|
| Service
Area |
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ENTIRE
U.S.A.
except Alaska |
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Designated
Provider Only |
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Designated
Provider Only |
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Designated
Provider Only |
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Preventative Dental Services
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NO
CLAIM FORMS |
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| Preventative
Deductible |
|
NO
DEDUCTIBLE |
|
$50
per person per year |
|
$50
per person lifetime |
|
$50
per person lifetime |
|
| Preventative
Maximum Benefit |
|
NO
LIMIT |
|
$1,500
Per Person Per Calendar Year |
|
$1,250
Per Person Per Calendar Year |
|
$1,000
Per Person Per Calendar Year |
|
| Preventative
Waiting Period |
|
NO
WAITING PERIOD |
|
1
month |
|
None |
|
None |
|
| Preventative
Exams |
|
70-82%
discount |
|
85% |
|
75%
first 12 months then 100% |
|
75%
first 24 months then 100% |
|
| Cleanings |
|
75-82%
discount |
|
85% |
|
75%
first 12 months then 100% |
|
75%
first 24 months then 100% |
|
| Preventative
X-Rays |
|
50-60%
discount |
|
50% |
|
Bitewings
75% first 12 months then 100% |
|
Bitewings
75% first 12 months then 100% |
|
| Fluoride |
|
50-70%
discount |
|
85% |
|
75%
first 12 months then 100% |
|
75%
first 24 months then 100% |
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Basic Dental Services
|
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NO
CLAIM FORMS |
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|
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| Basic
Deductible |
|
NO
DEDUCTIBLE |
|
$50
per person per year |
|
$50
per person per year |
|
$50
per person per year |
|
| Maximum
Benefit |
|
NO
SPENDING LIMIT |
|
$1,500
Per Person Per Calendar Year |
|
$1,250
Per Person Per Calendar Year |
|
$1,000
Per Person Per Calendar Year |
|
| Basic
Waiting Period |
|
NO
WAITING PERIOD |
|
6
months |
|
6
months |
|
6
months |
|
| X-Rays |
|
50-60%
discount |
|
All
X-Rays, 50/50 |
|
Diagnostic
25% for 7-12 month then 50% |
|
Diagnostic
25% for 7-12 month then 50% |
|
| Fillings |
|
50-60%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
25%
for 7-12 month then 50% |
|
| Sealants |
|
50-60%
discount |
|
NOT COVERED |
|
25%
for 7-12 month then 50% |
|
25%
for 7-12 month then 50% |
|
| Simple
Extractions |
|
50-75%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
25%
for 7-12 month then 50% |
|
| Space
Maintainers |
|
50-75%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
25%
for 7-12 month then 50% |
|
|
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Major Dental Services
|
|
NO
CLAIM FORMS |
|
|
|
|
|
|
|
| Major
Deductible |
|
NO
DEDUCTIBLE |
|
$50
per person per year |
|
$50
per person per year |
|
NOT COVERED |
|
| Major
Maximum Benefit |
|
NO
SPENDING LIMIT |
|
$750
Per Person Per Calendar Year |
|
$500
Per Person Per Calendar Year |
|
NOT COVERED |
|
| Major
Waiting Period |
|
NO
WAITING PERIOD |
|
18
months |
|
12
months |
|
NOT COVERED |
|
| Cosmetic
Dental |
|
25-50%
discount |
|
NOT
COVERED |
|
NOT
COVERED |
|
NOT
COVERED |
|
| Crowns |
|
25-50%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
| Bridges |
|
25-50%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
| Dentures |
|
25-50%
discount |
|
50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
| Peridontics |
|
25-50%
discount |
|
15
Month Waiting Period, 50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
| Endondontics |
|
25-50%
discount |
|
15
Month Waiting Period, 50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
| Oral
Surgery |
|
25-50%
discount |
|
15
Month Waiting Period, 50/50 |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
|
|
Orthodontic Services
|
|
NO
CLAIM FORMS |
|
|
|
|
|
|
|
| Orthodontics
Deductible |
|
NO
DEDUCTIBLE |
|
None |
|
None |
|
NOT COVERED |
|
| Orthodontics
Maxium Benefit |
|
NO
SPENDING LIMIT |
|
$350
per person per calendar year, $1,000 lifetime limit |
|
$500
per person per calendar year, $1,000 lifetime limit |
|
NOT COVERED |
|
| Orthodontics
Waiting Period |
|
NO
WAITING PERIOD |
|
18
months waiting period |
|
12
months waiting period |
|
NOT COVERED |
|
| Straightening
of Teeth |
|
25-50%
discount |
|
50% |
|
25%
for 7-12 month then 50% |
|
NOT COVERED |
|
|
|
Vision Plan Optical Plan (Eye Care)
|
|
Save
from 20 to 60% off for eyewear including contact lenses and glasses. Save up to 30% on eye
exams and surgeries. |
|
|
|
|
|
|
|
| Vision
Deductible |
|
NO
DEDUCTIBLE |
|
$50
per person per calendar year |
|
None |
|
None |
|
| Vision
Maximum Benefit |
|
NO
SPENDING LIMIT |
|
$150 |
|
$1,250 |
|
$1,000 |
|
| Vision
Waiting Period |
|
NO
WAITING PERIOD |
|
1
month for exam, 15 months for eyewear |
|
None
for exam, 12 months for eyeware |
|
None
for exam, 12 months for eyeware |
|
| Vision
Exams |
|
25-50%
discount |
|
85% |
|
75%
for first 12 months then 100% |
|
75%
for first 24 months then 100% |
|
| Eyewear |
|
25-60%
discount |
|
50% |
|
No
coverage first 12 months, 25% for 13-24th month then 50% |
|
No
coverage first 12 months, 25% for 13-24th month then 50% |
|
| Corrective
Surgery |
|
25-50%
discount |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
|
|
Prescription Plan
|
|
Prescription
plan offers up to 25% off most brand name prescriptions and up to 50% off
most generic drugs. Additional savings possible with mail order service. |
|
|
|
|
|
|
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| Brand
Name |
|
Up
to 25% |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
| Generic
Drugs |
|
Up
to 50% |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
| Local
Pharmacy |
|
YES |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
| Mail
Order |
|
YES |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
|
|
Chiropractic Plan
|
|
Free
initial consultation, 50% off all diagnostic services and x-rays, with an
additional 30% discount for all treatment. |
|
|
|
|
|
|
|
| Initial
Exam |
|
FREE |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
| X-Rays |
|
50%
discount |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
| Office
Visits |
|
30-50%
discount |
|
NOT COVERED |
|
NOT COVERED |
|
NOT COVERED |
|
|
|
| Additional
Information |
|
If you are not satisfied within the first 30 days, you can get
a 100% refund.
Plan offered for individuals or households, which includes EVERYONE in the household even if they are not related.
This plan is not an insurance but a discount plan. All applicants are guaranteed acceptance. All pre-existing conditions are covered, except braces in progress.
Plan requires that you use one of the 100,000+ participating providers of the plan. If your provider is not listed, a form can be provided to have the company contact your provider to become a member.
Services available in all states
except Alaska.
One time $20 enrollment fee due at sign-up. |
|
Plan
allows you to choose your own dentist and optometrist. Rates include a
$1.00 per month Administration Fee. $25 one-time enrollment fee due with
first premium payment. This provides a very brief summary of the benefits
of this plan. Upon submission of your application request, our office will
mail a copy of the benefit brochure which provides further details
regarding the coverages, limitations, and exclusions as well as the
application and premium payment options. Upon receipt of the completed
application and the appropriate premium, you will be notified of your
coverage effective date. |
|
Plan
allows you to choose your own dentist and optometrist. Rates include a
$1.00 PCPM Administration Fee. $25 one-time enrollment fee due with first
premium payment. |
|
Plan
allows you to choose your own dentist and optometrist. Rates include a
$1.00 PCPM Administration Fee. $25 one-time enrollment fee due with first
premium payment. |
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| Exclusions |
|
NONE |
|
Security Life - Dental
Expenses NOT COVERED:
No benefits will be paid for
expenses incurred: for charges in excess of those considered reasonable
and customary; for overdentures and associated procedures; for cosmetic
procedures; for the replacement of full and partial dentures, bridges,
inlays, onlays or crowns that can be repaired or restored to normal
function; for implants, and for (a) the replacement of lost or stolen
appliances, (b) the replacement of orthodontic retainers, (c) athletic
mouthguards, (d) precision or semi-precision attachments, (e) denture
duplication, or for (f) sealants; for oral hygiene instructions, and for
(a) plaque control, (b) the completion of claim form, (c) acid etch, (d)
broken appointments, (e) prescription or take-home fluoride, or for (f)
diagnostic photographs; for services not completed by end of the month in
which coverage terminates; for procedures that are begun, but not
completed; for those services for which there would be no charge in the
absence of insurance or for any service or treatment provided without
charge; for services in connection with war or any act of war, whether
declared or undeclared, or condition contracted or accident occurring
while on full-time active duty in the armed forces of any country or
combination of countries; for care or treatment of a condition for which
you are entitled to or eligible for benefits under any Worker's
Compensation Act or similar law; that are applied toward satisfaction of a
Deductible, if any; that are generally considered by the dental profession
as experimental or investigational; for the treatment of cleft palate and
anodontia; for services or supplies payable under any medical expense
plan; for orthodontia (unless specifically included); prior to the date
the insured is covered under the policy; for the diagnosis or treatment of
TMJ; for hospital services
Security Life - Vision
Expenses NOT COVERED:
The cost of a lens in excess of a standard
lens will not be covered. A standard lens is any lens which fits a frame
with an eye size less than 61 mm. Charges for replacement lenses will not
be covered unless there is a change in prescription. The cost of a frame
in excess of a standard frame will not be covered. A standard frame is any
frame which has a retail value of $75.00 or less. The cost of replacement
frames will not be covered, unless the existing frame is not compatible
with the replacement lenses. |
|
Baltimore Life - Dental
Expenses NOT COVERED:
No benefits will be paid for
expenses incurred: for charges in excess of those considered reasonable
and customary; for overdentures and associated procedures; for cosmetic
procedures; for the replacement of full and partial dentures, bridges,
inlays, onlays, or crowns that can be repaired or restored to normal
function; for implants, and for (a) the replacement of lost or stolen
appliances, (b) for replacement of orthodontic retainers, (c) athletic
mouthguards, (d) precision or semi-precision attachments, or for (e)
denture duplication; for oral hygiene instructions, and for (a) plaque
control, (b) the completion of claim forms, (c) acid etch, (d) broken
appointments, (e) prescription or take-home fluoride, or for (f)
diagnostic photographs; for services not completed by end of the month in
which coverage terminates, unless continuation of coverage has been
requested by Us; for procedures that are begun, but not completed; for
those services for which there would be no charge in the absence of
insurance or for any service or treatment provided without charge; for
services in connection with war or any act of war, whether declared or
undeclared, or condition contracted or accident occurring while on
full-time active duty in the armed forces of any country or combination of
countries; for care or treatment of a condition for which you are entitled
to or eligible for benefits under any Workers' Compensation Act or similar
law; that are applied toward satisfaction of a Deductible, if any; that
are generally considered by the dental profession as experimental or
investigational; for the treatment of cleft palate and anodontia; for
services or supplies payable under any medical expense plan; for
orthodontia (unless specifically included); prior to the date the insured
is covered under the Policy; for the diagnosis or treatment of TMJ; for
hospital services.
Baltimore Life - Vision
Expenses NOT COVERED:
The cost of a lens in excess of a standard
lens will not be covered. A standard lens is any lens which fits a frame
with an eye size less than 61mm. Charges for replacement lenses will not
be covered unless there is a change in prescription. The cost of a frame
in excess of a standard frame will not be covered. A standard frame is any
frame which has a retail value of $75.00 or less. The cost of replacement
frames will not be covered, unless the existing frame is not compatible
with the replacement lenses. In addition to the above, the following
expenses are NOT COVERED: any procedure, service or supply included as a
covered medical expense under any group insurance plan, whether benefits
are payable as to all or only part of such charges; special procedures,
such as orthoptics, vision training, and subnormal vision aids; plano or
prescription sunglasses or other special purpose vision aids; medical or
surgical treatment of the eyes, including hospital expenses; replacement
of lost or broken lenses and/or frame; duplicate glasses or lenses or
frame; services or material not listed as an Eligible Expense; contact
lenses are provided in lieu of all other eyewear benefits, if the visual
acuity of the insured is 20/70 or worse in the insured's better eye
limited to one pair in any 24 months.
|
|
Baltimore Life - Dental
Expenses NOT COVERED:
No benefits will be paid for expenses
incurred: for charges in excess of those considered reasonable and
customary; for overdentures and associated procedures; for cosmetic
procedures; for the replacement of full and partial dentures, bridges,
inlays, onlays, or crowns that can be repaired or restored to normal
function; for implants, and for (a) the replacement of lost or stolen
appliances, (b) for replacement of orthodontic retainers, (c) athletic
mouthguards, (d) precision or semi-precision attachments, or for (e)
denture duplication; for oral hygiene instructions, and for (a) plaque
control, (b) the completion of claim forms, (c) acid etch, (d) broken
appointments, (e) prescription or take-home fluoride, or for (f)
diagnostic photographs; for services not completed by end of the month in
which coverage terminates, unless continuation of coverage has been
requested by Us; for procedures that are begun, but not completed; for
those services for which there would be no charge in the absence of
insurance or for any service or treatment provided without charge; for
services in connection with war or any act of war, whether declared or
undeclared, or condition contracted or accident occurring while on
full-time active duty in the armed forces of any country or combination of
countries; for care or treatment of a condition for which you are entitled
to or eligible for benefits under any Workers' Compensation Act or similar
law; that are applied toward satisfaction of a Deductible, if any; that
are generally considered by the dental profession as experimental or
investigational; for the treatment of cleft palate and anodontia; for
services or supplies payable under any medical expense plan; for
orthodontia (unless specifically included); prior to the date the insured
is covered under the Policy; for the diagnosis or treatment of TMJ; for
hospital services.
Baltimore Life - Vision
Expenses NOT COVERED:
The cost of a lens in excess of a standard
lens will not be covered. A standard lens is any lens which fits a frame
with an eye size less than 61mm. Charges for replacement lenses will not
be covered unless there is a change in prescription. The cost of a frame
in excess of a standard frame will not be covered. A standard frame is any
frame which has a retail value of $75.00 or less. The cost of replacement
frames will not be covered, unless the existing frame is not compatible
with the replacement lenses. In addition to the above, the following
expenses are NOT COVERED: any procedure, service or supply included as a
covered medical expense under any group insurance plan, whether benefits
are payable as to all or only part of such charges; special procedures,
such as orthoptics, vision training, and subnormal vision aids; plano or
prescription sunglasses or other special purpose vision aids; medical or
surgical treatment of the eyes, including hospital expenses; replacement
of lost or broken lenses and/or frame; duplicate glasses or lenses or
frame; services or material not listed as an Eligible Expense; contact
lenses are provided in lieu of all other eyewear benefits, if the visual
acuity of the insured is 20/70 or worse in the insured's better eye
limited to one pair in any 24 months.
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* Family of 2 adults and 2 children used for Insurance rate calculations.
DentalCard rate is the same for 2 or more persons at same household address.