|Coinsurance||0% - Preventive/Diagnostic
20% - Basic
50% - Major
|Deductible||$50 per insured Waived for preventive and diagnostic services|
|Annual Maximum Benefit||$1,500|
|Teeth Cleanings||No Charge 2 per calendar year|
|Restorative Dentistry/Fillings||20% Coinsurance after deductible|
|Oral Surgery||50% Coinsurance after deductible|
|Extractions||20% Coinsurance after deductible|
|X-Rays||No Charge Bitewings - 1 per calendar year Full/Pano - 1 per 36 months|
|Crowns||50% Coinsurance after deductible|
|Root Canals||50% Coinsurance after deductible|
|Periodontics||50% Coinsurance after deductible|
|Dentures||50% Coinsurance after deductible|
|Topical Fluoride||No Charge Limited to 1 per year, dependent children under age 16.|
|Sealant||No Charge Limited to dependent children under age 14.|
|Bridges||50% Coinsurance after deductible|
|Endodontics||50% Coinsurance after deductible|
|A.M. Best Rating||A- as of 12/19/2018|
|Electronic Signature for Application Available||Yes|
|Details and documents about this plan|
|View Plan Brochure Exclusions and Limitations|
Important notices and disclaimers
- The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
- The benefits listed may be contingent on your use of physicians, hospitals, dentists and services within the specific insurance company's provider network.
- The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
- The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history (pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
Carrier specific notices, disclaimers and fees
- - These products are not qualifying health coverage ("Minimum Essential Coverage") that satisfies the health coverage requirement of the Affordable Care Act. If you don't have Minimum Essential Coverage, you may owe an additional payment with your taxes. The termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period. These products may include a pre-existing condition exclusion provision.
- - eHealth Dental is not available in all states. Availability in a state is subject to change.
- - Different plan designs offer various levels of coverage, out of pocket costs, and dentist availability. These choices vary by state. For complete details please review IAIC IDEN POL 0414 and state specific variations where applicable.
- - If a plan design includes a copay, the copay applies to all services listed; except in Connecticut, where the copay only applies to exams, cleanings, topical fluoride, sealants and space maintenance.
- - The application must be received by the administrator prior to the requested effective date, and the initial premium must be received by the administrator prior to issuing coverage. If a monthly billing method has been selected, future payments will be due monthly on the billing date.
- - Do not lapse or cancel current insurance coverage unless you receive a written notice from the insurance company that your application for coverage has been approved .
- - This Policy is underwritten by Independence American Insurance Company, (IAIC), domiciled in Delaware, a member of the IHC Group. For more information about IAIC, visit the website at www.independenceamerican.com or call 212-355-4141.
- - This Policy is administered by The Loomis Company acting as a third party (authorized) administrator on behalf of Independence American Insurance Company (Read more).
- - Important – Information regarding coverage under your benefits plan (Read more).