American Dental Plans for individuals

Dental Of America - Family Dental Insurance

The American dental insurance plans are based upon the zip code and their availability. If we are unable to offer a dental insurance plan, we will provide a alternative dental plan, if available, and clearly state it. American Dental Plans for individuals

Please be sure to contact the plan dental office to confirm they are accepting new patients and they are accepting the dental plan you have selected.

If you have any dental insurance plan questions please feel free to contact our office during regular business hours. You will find our licensed insurance agents ready to assist you.

Extension of eligibility may be made up to the age of 23 years for unmarried children who are principally dependent upon the subscriber and are registered students in regular, full-time attendance at an accredited school, college, or university (subscriber will be required to submit evidence of full-time status). American Dental Plans for individualsThere are no deductibles and no yearly limits on services, and there are no claim forms to fill out. The dentists must meet the Plan's standard of quality and service. All have agreed to provide dental care at a low cost available only to its members. There is no waiting period for your dental services to begin, pre-existing dental conditions are covered. A reminder your application must be received by the company on or before the last day of the month prior to the following month's coverage effective date.

An Enrollment Application is a request for coverage, which, if approved by California Dental Network, becomes the enrollment form used to issue an identification card and Combined Evidence of Coverage and Disclosure Form. All benefits, limitations and exclusions are stated in full in the Combined Evidence of Coverage and Disclosure Form which is provided American Dental Plans for individualswhen coverage becomes effective. Members will have 30 days from receipt of the Combined Evidence of Coverage and Disclosure Form to cancel their enrollment and receive a full refund of their premiums if they have not utilized the Plan. You may obtain a copy of the Combined Evidence of Coverage and Disclosure Form from their Corporate Office before you enroll.

Limitations (1) Prophylaxis (cleaning) is limited to once every six months. (2) Fluoride treatment is covered once every 12 months for Members up to age 14. (3) Bitewing x-rays are limited to one series of four films every 12 months. (4) Full mouth x-rays are limited to once every 24 months. (5) Sealants are covered for Members up to the age of 14 and are limited to permanent first and second molars. (6) Periodontal treatments (subgingival curettage and root planning) American Dental Plans for individualsare limited to one treatment per quadrant in any 12-month period. (7) Fixed bridgework will be covered only when a partial cannot satisfactorily restore the case.(8) Replacement of partial dentures is limited to once every five years. (9) Full upper and/or lower dentures are not to exceed one each in any five-year period. (10) Denture relines are limited to one per arch in any 12-month period.

Exclusions (1) General anesthesia, analgesia (nitrous oxide), intravenous sedation, or the services of an anesthesiologist. (2) Treatment of fractures or dislocations; congenital malformations; malignancies, cysts, or neoplasms; or Temporomandibular Joint Syndrome (TMJ). (3) Extractions or x-rays for orthodontic purposes. (4) Prescription drugs and over the counter drugs. (5) Any services involving implants or experimental procedures. (6) Any procedures performed for cosmetic, elective or aesthetic purposes. (7) Any procedure to replace or
American Dental Plans for individualsstabilize tooth structure lost by attrition, abrasion, erosion or grinding.

Not all general dentists are capable of performing each of the services listed herein and, based upon the Memberís condition, certain procedures may not be within the scope of practice or ability of a general dentist. In such cases, the general dentist will refer the Member to a California Dental Network participating dental specialist, who will give the Member a 30% discount from their regular fees during the first year of enrollment, and a 50% discount thereafter, for up to $1,000 in services per year. The ratio of premium costs to health services paid, for plan contracts with individuals and groups of 25 or fewer members, during the preceding fiscal year was 0%. * UCR means the dentistís or specialistís Usual, Customary & Reasonable fees. # Member is responsible for the payment shown plus the actual lab cost of gold. Orthodontists may charge Members additional fees for costs of cases over 24 months, based on the differences in UCR fees for the needed treatment periods less the UCR fees for a 24-month treatment period.