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Individual Dental Plan

Georgia - Overview & Prepayment Fees

Select Plan

This is not an insurance policy. This plan is not under the jurisdiction of the insurance laws of the State of Georgia.

DentiCare provides you an individual dental plan with quality benefits and attractive prepayment fees. To receive the benefits of the DentiCare SelectSM Plan you will need to select a Plan Dentist for you and your family members from the list of Plan Dentists. Please note that you may choose a different Plan Dentist for each family member.

Features of the DentiCare SelectSM Plan:

  • No deductibles
  • No claim forms
  • No annual dollar maximum for plan dentists and specialists
  • Fixed Copayment Schedule
  • Discounts on Orthodontic procedures for children and adults
  • No referral required for Specialist benefits
  • Benefits for pre-existing dental conditions
  • Enroll by phone for the annual prepayment fee method - Call 800-347-4090

Frequently Asked Questions


 

 Prepayment fee options

Economical Annual Prepayment Fee

Individual

$127.20

Individual & One Dependent

$211.56

Family

$328.44


or

Automatic Monthly Bank Draft

Accounts are drafted on the 15th of each month prior to the month of coverage.

Individual

$11.60

Individual & One Dependent

$18.63

Family

$28.37


$35.00 Enrollment Fee

How does the plan work?

Dentists who participate in this prepaid dental plan have agreed to offer services to plan members at a discount. Members pay the Plan Dentist his or her discounted fee directly. These discounted fees are called copayments. Not all services are subject to discounts. A sample of the copayments for this plan is included in this site.

Cosmetic dentistry

We know how important a great smile is to you, as well as the benefits of having the smile that you want and deserve. That's why we have included some cosmetic procedures, such as bleaching and bonding, in the list of copayments.

Vision discount plan

A vision discount plan is included with your dental plan. The vision plan includes discounts on eye exams, eyeglasses, contact lenses and other prescription eyewear when provided by participating providers. Upon your enrollment, information regarding the vision plan will be mailed to you. For more information on the vision discount plan, call 800-347-4090.

Orthodontic benefits

The Select Plan includes discounts on Orthodontic procedures for children and adults. Plan Orthodontists provide discounts of 25% off his or her list charge. Orthodontic services are available only in areas where DentiCare has Plan Orthodontist(s) or Plan Dentist(s) who provides those services. Orthodontic treatment begun prior to your plan effective date is not eligible for this discount.

Specialist benefits

Should the service of a specialist (Oral Surgeon, Endodontist, Orthodontist, Periodontist, or Pedodontist) be necessary you may seek treatment from any Plan Specialist listed in our printed or online directory. If an Oral Surgeon, Orthodontist, Periodontist or Pedodontist provides treatment you will receive 25% off list charges. For treatment by an Endodontist you will receive 15% off list charges. Specialist services are available only in areas where DentiCare has Plan Specialist(s).

Please note that payment for a service performed by a Non-Plan Specialist is your responsibility.

How do I join?

Three easy steps to enrolling in the Select Plan:

  1. Select a general dentist from the Plan Dentist Directory. Each family member may choose a different Plan Dentist.

  2. Complete the online enrollment form. Be sure to include the Dental Facility Number of each dentist you have selected in the space provided and print the enrollment form.

  3. Choose your payment option.

    If you choose the annual prepayment fee method include the appropriate prepayment fee, the $35 enrollment fee, the completed application form and mail to Assurant Employee Benefits. The annual prepayment fee may be paid by credit card for your convenience. You may enroll over the phone if you are choosing the annual prepayment fee method.

    If you choose the automatic monthly bank draft method complete the Authorization Agreement included in this site under "Enrollment Form," include a voided check, the first month's prepayment fee, the $35 enrollment fee and mail to Assurant Employee Benefits. Monthly prepayment fees will thereafter be drawn automatically from your bank account. While we accept automatic bank drafts from checking or savings accounts, we cannot accept personal checks on a monthly basis.

When will I receive a membership card?

Once your application has been processed, you will receive a membership card, the Individual Dental Prepaid Plan Agreement, and a complete list of copayments.

What if I need To change my dentist?

You may make a request to change dentists at anytime by simply calling Customer Service at 800-443-2995 to select another participating provider.

Who is eligible?

You, your spouse and legal dependents under the age of 28 are eligible for dental benefits.

Limitations and exclusions

  1. Medical costs associated with dental procedures.

  2. Dental services or procedures which are not listed on the Benefits and Copayment Schedule.

  3. Emergency Services received from a dentist who is not Member's selected Plan Dentist.

  4. Certain services may only be obtained once in any six calendar months, with a maximum of twice in the same calendar year. Those services are listed on the Benefits and Copayment Schedule as ADA Codes 0120, 0150, 0272 and 0274.

  5. Certain services may only be obtained once in any 3 calendar years. Those services are listed on the Benefits and Copayment Schedule as ADA Codes 0210 and 0330.

  6. Services rendered by a Plan Provider because of behavior adjustment. Such services include, but are not limited to, physical restraint or sedation.

  7. Replacement of dentures or appliances received during enrollment in Plan, if Member has had dentures or appliance less than five years. (Note: If dentures or appliance becomes unserviceable due to illness or causes not controlled by ordinary means, the following will apply. Replacement will be made only if existing denture or appliance cannot be made serviceable.)

  8. Replacement of dentures, appliances or bridgework due to loss or theft.

  9. Dental treatment provided or started prior to Member's eligibility to receive benefits.

  10. Dental treatment started after Member's termination.

  11. Dental treatment caused by failure to follow prescribed treatment.

  12. Ongoing orthodontic treatment past eighteen (18) consecutive months.

  13. Orthodontic treatment involving therapy for myofunctional problems, T.M.J. dysfunctions, micrognathia, macroglossia, cleft palate or hormonal imbalances causing growth and developmental abnormalities.

  14. Orthodontic cases involving orthognathic surgery.

  15. Treatment for malignancies, neoplasms or cysts (including biopsies).

  16. Lab fees associated with services listed on the Benefits and Copayments Schedule.

  17. Restorations and splints used to increase vertical dimension, restore occlusion, or replace/stabilize tooth structure loss by attrition.

  18. Fixed prosthetic restoration of six (6) or more existing teeth, when performed as a single procedure or as part of a complete oral rehabilitation or reconstruction.

  19. Complete oral rehabilitation or reconstruction involving replacement of six (6) or more missing teeth using fixed prosthetic restorations and/or appliances.

  20. Dental treatment if Member's general health or physical limitations prevent Plan Provider from rendering appropriate dental treatment.

  21. Costs associated with prescriptions or over the counter medications.

  22. Implants, surgery for the insertion of implants, all related implant appliances and restorations, whether removable or fixed.

  23. Surgical removal of implants, or any surgery required to adjust, replace, or treat any problem related to an existing implant, or implant appliance.

Renewable at Option of Company
 

Georgia Plan Information

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