With today's soaring healthcare costs, you may prefer to offer your employees a comprehensive voluntary dental plan that includes coverage for preventive, basic and major services. Our DentalCare 1200 Plan covers allowable charges for dental services at 100% coverage for preventive services, at 80% for basic services and at 50% coverage for major services. The combined lifetime deductible is only $100 per person which applies to all covered dental services. There is a maximum contract year benefit of $1200 per person. DentalCare 1200 plan features:

Routine exams

Two every 12 months

None

Cleanings

Two every 12 months

None

Fluoride treatment for children under age 19

One per 12 months

None

Bitewing X-rays

Two per 12 months

None

Space maintainers

None

Sealants for children ages 6 through 15

One per tooth per 36 months

None

Emergency treatment for dental pain (minor procedures)

None

Simple teeth removal

Six month waiting period

Simple restorative services (fillings)

Six month waiting period

X-rays (full mouth or panorex,)

One per 36 months

Six month waiting period

Root canals and treatment involving the roots of teeth

Six month waiting period

Endodontics – Root canals and treatment involving the roots of teeth

Six month waiting period

Periodontics – the treatment involving the bones, tissues and gums surrounding or supporting a tooth

Major restorative services (crowns, inlays and onlays)

Six month waiting period

Prosthodontics (bridges, dentures)

Six month waiting period

Surgical teeth removal and other oral surgery

Six month waiting period

Denture relines (if over six months after installation)

Six month waiting period

Recementation and repair of crowns, inlays, bridges and dentures

Six month waiting period

Medically appropriate anesthesia related to covered surgery

Six month waiting period

No Deductible; 50% Coverage

Twelve month waiting period

$1000 Lifetime Maximum Benefit

Applies only to children under age 19

If premium costs are a barrier to you offering a dental program, then our DentalCare 1000 Plan may be your solution. This plan covers allowable charges for dental services at 100% coverage for preventive services, at 80% for basic services and at 50% coverage for major. The combined lifetime deductible is only $100 per person which applies to all covered dental services. There is a maximum contract year benefit of $1000 per person. DentalCare 1000 plan features:

Routine exams

One every 12 months

None

Cleanings

One every 12 months

None

Fluoride treatment for children under age 19

One per 12 months

None

Bitewing X-rays

One per 12 months

None

Space maintainers

Six month waiting period

Sealants for children ages 6 through 15

Six month waiting period

Emergency treatment for dental pain (minor procedures)

Six month waiting period

Simple restorative services (fillings)

Six month waiting period

X-rays (full mouth or panorex,)

Six month waiting period

Endodontics – Root canals and treatment involving the roots of teeth

Periodontics - the treatment involving the bones, tissues and gums surrounding or supporting a tooth

Twelve month waiting period

Major restorative services (crowns, inlays and onlays)

Twelve month waiting period

Simple teeth removal

Twelve month waiting period

Prosthodontics (bridges, dentures)

Twelve month waiting period

Surgical teeth removal and other oral surgery

Twelve month waiting period

Denture relines (if over six months after installation)

Twelve month waiting period

No Deductible; 50% Coverage

Twelve month waiting period

$1000 Lifetime Maximum Benefit

Applies only to children under age 19

This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. Please see your certificate for details.

Eligibility: To qualify for either of these benefit plans, either two employees or 20% of your eligible group must participate, whichever amount is greater. The employer selects the plan that’s best for the employees. Employers with 100 or more eligible employees may elect to offer both plans for employee choice. Orthodontia must have three enrollees.
Takeover Benefits: Takeover means that we give employees credit for waiting periods for similar coverage they accumulated under your existing group dental plan.
1. Your current group dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan.
2. All employees insured on the effective date with continuous coverage from the prior group dental contract are eligible for takeover benefits. Waiting periods will be reduced by the amount of time the employee had coverage under the prior plan.
3. Takeover benefits are subject to our approval.

Dependents: Eligible dependents include the insured employee’s spouse and unmarried children prior to their 19th birthday who do not work for the firm. In addition, unmarried children from their 19th birthday to the day before their 24th birthday are eligible if they are primarily dependent upon the employee for more than 50% of their support and maintenance and are listed as dependents on the employee’s Federal tax return.

Predetermination of Benefits: For your employees’ protection, Companion Life will provide predetermination of benefits for recommended treatment plans that exceed $300. This benefit helps employees better understand their coverage. It explains which recommended procedures are covered and at what amount. Employees should submit the treatment plan to Companion Life for review and predetermination of benefits before receiving the service.

*These forms are in PDF format, and require
the Adobe Acrobat Reader for viewing.
Click here to download Free Acrobat Reader

• Companion Life Voluntary Dental Plan Comparison
• Companion Life Voluntary Dental Brochure
• Companion Life Voluntary Dental Rates
• Companion Life Voluntary Dental Employee Enrollment Form
• Companion Life Voluntary Dental Group Application