Cascade Mountains
CITIES: Brightwood, Camp
Sherman,
Cascade Locks, Cascadia, Chemult,
Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew,
Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha,
Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North
Umpqua, Oakridge, Prospect, Rhododendron, Sandy,
Sisters,
Sunriver, Warm Springs,
Welches, Westfir, Zigzag
AREAS: Crater Lake National Park, Deshutes National Forest,
Fremont National Forest, Mount Hood National Forest, Rogue River
National Forest, The Three Sisters, Umpqua National Forest, Willamette
National Forest, Winema National Forest
Central Oregon
CITIES: Antelope,
Arlington,
Bend, Brothers, Condon, Culver, Dufur,
Fossil, Grass Valley, Hampton, Lonerock,
Madras, Maupin, Metolius, Mitchell, Moro,
Mosier, Paulina, Post, Prineville,
Redmond, Rowena,
Rufus, Shaniko, Spray,
The Dalles, Wasco
Northeast Oregon
CITIES: Adams, Arlington,
Athena,
Baker City, Boardman, Canyon City, Condon,
Cove, Dayville, Echo, Elgin,
Enterprise, Fossil, Greenhorn, Haines, Halfway,
Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day,
Joseph,
La Grande, Lexington, Long Creek, Lostine,
Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow,
Pendleton, Pilot Rock, Prairie City,
Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity,
Wallowa, Weston
AREAS:
Hell's Canyon
Oregon Coast
North Coast
Astoria, Bay City, Beaver,
Cannon Beach,
Garibaldi,
Gearhart, Hebo,
Nehalem,
Manzanita, Neahkahnie, Oceanside,
Pacific City,
Rockaway Beach,
Seaside,
Tillamook,
Warrenton,
Wheeler
Central Coast
Depoe Bay,
Dunes City,
Florence,
Gleneden Beach,
Lincoln City, Mapleton,
Newport, Otter Rock, Reedsport, Seal Rock,
Siletz,
Toledo,
Waldport,
Winchester Bay,
Yachats
South Coast
Agness,
Bandon,
Brookings,
Charleston,
Coos Bay, Coquille,
Gold Beach,
Lakeside,
Myrtle Point,
North Bend,
Port Orford, Powers, Wedderburn
Portland and Vicinity
Banks, Barlow,
Beaverton, Camas, Canby,
Clackamas, Clatskanie, Columbia City,
Cornelius,
Forest Grove, Gaston,
Gresham, Happy Valley,
Hillsboro,
Lake Oswego, Marquam,
Milwaukie, Molalla, North Plains,
Oregon City,
Portland, Rainier, Sandy, Scappoose, St.
Helens,
Tigard, Troutdale,
Tualatin, Vernonia, West Linn,
Wilsonville
Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey,
Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa,
Ontario, Plush, Vale
Southern Oregon
CITIES:
Ashland, Butte Falls, Cave Junction,
Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale,
Glide, Gold Hill,
Grants Pass, Jacksonville, Klamath Falls, Malin,
Medford,
Merlin, Myrtle Creek, Oakland, Phoenix,
Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent,
Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS: Applegate Valley, Illinois Valley
Willamette Valley
Albany, Alsea, Amity, Aumsville,
Aurora, Brooks,
Brownsville, Canby, Canyonville, Carlton,
Corvallis, Coburg, Cottage Grove, Creswell,
Culp Creek, Dallas, Dayton, Detroit, Donald,
Dundee,
Eugene, Falls City, Gates, Gervais, Halsey,
Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell,
Lyons,
McMinnville, Mill City, Millersburg, Mt.Angel,
Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath,
Salem, Scio, Scott Mills, Sheridan,
Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home,
Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill
|
| |
|
|
Affordable, Low Cost Dental Plans
Talk with a real
person 9:00 am to 9:00 pm 503-922-2903
877-786-8347
|
|
This product
is currently only available to residents in Oregon.
Plan Description and Information (pdf)
Managed Care Dental
Managed Care
Dental offers you a variety of services covered at predictable
copays. Youll work with a participating provider who can combine the
best available scientific evidence with clinical experience to develop
a personalized oral health plan for you.
MONTHLY PREMIUM PER POLICY
Family Status, Dental, Dental & Only
Vision
Individual $31.00 $ 36.50
Indiv. & Spouse $63.00 $ 74.00
Indiv. & Child $60.00 $ 68.30
Family $90.00 $108.00
|
Careington Affordable, Low Cost Dental
Find a Provider Near You
$11.95 Dental Vision Plan
Fee Schedule 505
"Recommended
Dentist"
Dr.
Dan Thompson
971-236-9356 17704 SW
Jean Way, Ste 105, Lake Oswego, OR 97035
CAREINGTON DENTAL, DISCOUNT DENTAL
PLANS
Free Instant Individual - Family Careington
Dental Plan Quotes |
|
Members
can save on all dental charges and procedures including dental
restorative cosmetic work (fillings, dental crowns, dental braces,
dental implant's) and dental product related items, etc.), dental
hygiene services, preventative work (teeth cleaning, x-rays,
etc). General dentistry, dental hygienist, dental assistant,
dental assisting and all specialties where available are covered.
Save 20% to 60% on most
dental procedures including routine oral exams, unlimited
cleanings, and major work such as dentures, root canals and
crowns. The CAREINGTON dental plan is backed by our SATISFACTION
GUARANTEE. We have carefully selected the combined Careington
Dental Plan and EyeMed Vision Care, two of the nations largest and
best providers in their area of specialty.
Careington
Dental Fee Schedules
Careington Dental Plan 500 Series -
Plan 501
Careington Dental Plan 500 Series -
Plan 502
Careington Dental Plan 500 Series -
Plan 503
Careington Dental Plan 500 Series -
Plan 504
Careington Dental Plan 500 Series -
Plan 505
Careington Dental Plan 500 Series -
Plan 506
Careington Dental Plan 500 Series -
Plan 507
Careington Dental Plan 500 Series -
Plan 508
Careington Dental Plan: Includes
x-rays, exams, cleanings, fillings, extractions, root canals,
crowns, bridges, dentures, oral surgery, children's dentistry,
Orthodontics, Periodontics, Endodontics, and more. Over 7 million
members join the Careington Dental Plan. CAREINGTON was among the
first to offer quality dental plans at a discount, we have had
years to develop an extensive provider panel, with over 35,000
participating dentists. Immediate access available to the
Careington dental plan You can include your parents and other
family members under certain conditions.
CAREINGTON DENTAL PLANS HAVE
BEEN APPROVED IN THE FOLLOWING STATES.
Alabama,
Alaska,
Arizona,
Arkansas,
California,
Colorado,
Connecticut,
Delaware,
Florida,
Georgia,
Hawaii,
Idaho,
Illinois,
Indiana,
Iowa,
Kansas,
Kentucky,
Louisiana,
Maine,
Maryland,
Massachusetts,
Michigan,
Minnesota,
Mississippi,
Missouri,
Montana,
Nebraska,
Nevada,
New Hampshire,
New Jersey,
New Mexico,
New York,
North Carolina,
North Dakota,
Ohio,
Oklahoma,
Oregon,
Pennsylvania,
Rhode Island,
South Carolina,
South Dakota,
Tennessee,
Texas,
Utah,
Vermont,
Virginia,
Washington,
West Virginia,
Wisconsin,
Wyoming.
DISCLOSURE: THIS PLAN IS NOT
INSURANCE. THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN.*
The plan provides discounts at certain health care providers
for medical services. The range of discounts will vary depending
on the type of provider and service. The plan does not make
payments directly to the providers of medical services. Plan
members are obligated to pay for all health care services but will
receive a discount from those health care providers who have
contracted with the discount medical plan organization. Before
purchase, you may access a list of participating health care
providers at Careington Providers.com.
|
|
|
|
|
|
|
|
Careington
|
|
CAREINGTON is one of the largest, most
comprehensive, privately held discount health care companies in
America. Through esteemed networks of providers, ancillary products
and specialty services covering the full continuum of care, CAREINGTON
offers innovative programs to compliment traditional health insurance
and provide substantial savings for under insured and uninsured
individuals. |
|
Our Mission
CAREINGTON is one of the largest, most
comprehensive, privately held discount health care companies in
America. Through esteemed networks of providers, ancillary products
and specialty services covering the full continuum of care, CAREINGTON
offers innovative programs to compliment traditional health
insurance and provide substantial savings for under insured and
uninsured individuals.
Core Purpose
To improve the health and well-being of
individuals.
Core Value
Everything we do will be driven by:
Systematic improvement in the quality of dental care
Respect for the patient-provider relationship
Commitment to leading-edge innovation
Compassion for people
Honesty and integrity
Business Goal
To be the recognized leader in designing,
organizing and managing health care services in communities across the
United States. As a company, we will achieve this through a
customer-driven focus that emphasizes:
Quality. We will improve the quality of care by helping to
identify the most effective treatments, based on scientific
evidence, and sharing this information with providers, customers,
members and the public.
Value. We will deliver more value for the dollar to our
customers than our competitors.
Service. We will strive to deliver unparalleled service to
our members.
Efficiency. We will manage dental health care resources
efficiently and be disciplined about controlling costs.
Access. We will provide equitable and appropriate access to
care and deliver products that provide choice for consumers.
Education. We want members to play an active role in managing
their own dental health and will provide them with information and
support that will help them lead healthier lives.
Accountability. We will provide objective information that
will allow customers, members, and dental care providers to evaluate
our performance.
Return to
TopGuiding Principles
As employees, we will:
Look beyond the horizon. We will not be content with the
status quo. We will continue to explore new opportunities, propose
new ideas, and search for better ways to meet the needs of our
customers.
Work together. No one has all the answers. We will treat
each other with respect and solicit advice and assistance from our
co-workers. The best work comes from sharing our talents and hard
work with each other.
Think like customers. In every decision we make, we will
consider the value it provides to our customers. We will treat our
members the way we would want to be treated with compassion,
respect, and unsurpassed services.
Act like owners. We will take responsibility for moving
business objectives forward. We will continually raise our own
expectations of what can be accomplished, and we will hold
ourselves accountable for reaching the goals we set.
CAREINGTON POS Dental Network
Provider Network: Over 54,000* available dental
practice locations nationwide
Discount Range: Save 20%-50% on everything from
general dentistry and cleaning to root canals, crowns and
orthodontia, 20% savings for specialists
Sample Savings
|
Product/Service |
Average Cost * |
CI-5 Schedule Price |
Total Savings |
|
Adult
Cleaning |
$82
|
$52
|
$30
|
|
Child
Cleaning |
$49
|
$37
|
$12
|
|
Routine Checkup |
$39
|
$27
|
$12
|
|
Four
Bitewing X-rays |
$51
|
$31
|
$20
|
|
Composite (White) Filling |
$131
|
$76
|
$55
|
|
Crown
(porcelain fused to noble metal)
|
$843
|
$584
|
$259
|
|
Complete Upper Denture |
$940
|
$763
|
$177
|
|
Molar
Root Canal |
$826
|
$581
|
$245
|
|
Extraction (single tooth) |
$119
|
$70
|
$49
|
* Actual
savings may vary
CAREINGTON
International Corporation
Limitations.
This is a discount program. This is not an insurance plan. CAREINGTON
cannot guarantee specialty care in all areas. In cases in which you
are referred to a participating specialist, you will generally
receive 15% to 20% off their usual and customary fees. Please verify
such benefits with each individual provider. Work in progress, after
joining the plan, must be completed by the provider who started the
work. Any procedures performed by a non-participating provider are
not included. CAREINGTON International cannot guarantee the
continued participation of any provider. If he or she leaves the
plan, you will need to select another provider. Not all types of
providers may be available in your area. Some providers may charge
for missed or broken appointments if no prior notice is given. It is
the members responsibility to verify that the provider is a
participating provider. This plan does not include all procedures
which might be provided. Any procedure delivered which is not listed
on the Schedule of Services may cause additional cost to be incurred
by the member. The dollar amount specified adjacent to each
procedure may not be the only cost incurred for a given treatment
because the treatment may require more than one procedure. Note to
Utah Residents: This contract is
not protected by the
Utah
Life and Health Guaranty Association. The program and the program
administrators have no liability for providing or guaranteeing
service and have no liability for the quality of service rendered.
|
|
|
Can drinking milk prevent tooth decay?
My six-year-old son has a cavity in one of his
baby molars. Should I bother to have it fixed since he's going to
lose it anyway?
Is there any relationship between teeth and
sinus problems?
What is a crown?
Why do some teeth need fillings while others
need crowns?
Is it always necessary to crown a tooth after
a root canal?
If a tooth needs a crown, do I have to have a
root canal?
Are yellow teeth a sign of bad oral hygiene?
Are dental whiteners and polishers good for
teeth?
How much toothpaste per brushing is
recommended?
What is the difference between fluoride rinse
and fluoride tablets?
What is a tooth abscess?
Why are "sealants" sometimes recommended for
children's teeth
and how do they work?
Dental Health During Pregnancy
Mouth Injuries
Dental Do's - Birth to 3 Years
|
A
B
C
D
E
F
G
H
I
L
M
N
P
Q
R
S
T
U
V
W
A tooth or implant used to support a
prosthesis. A crown unit used as part of a fixed bridge.
A localized inflammation due to a
collection of pus in the bone or soft tissue, usually caused by an
infection.
A tooth or implant used to support a
prosthesis. A
crown
unit used as part of a fixed
bridge.
An event or occurrence which is
unforeseen and unintended.
A form of insurance against loss by
accidental bodily injury.
The tendency of persons who present a
poorer-than-average risk to apply for, or continue, insurance to a
greater extent than do persons with average or better-than-average
expectations of loss.
An insurance company
representative licensed by the state who solicits, negotiates or
effects contracts of insurance, and provides service to the
policyholder for the
insurer.
Career agents who place business with
companies other than their primary companies. Also known as agents
of other companies, surplus brokers, or simply
brokers.
A surgical procedure used to recontour
the supporting bone structures in preparation of a complete or
partial denture.
A dental filling material, composed of
mercury and other minerals, used to fill decayed teeth.
A class of drugs that eliminates or
reduces pain. See
local anesthetic.
Refers to the teeth and tissues located
towards the front of the mouth (upper or lower
incisors and
canines).
The tip or end of the
root
of the tooth.
The amputation of the
apex
of a tooth.
The party applying for an insurance
policy.
A form that must be completed by an
individual or other party who is seeking insurance coverage. This
form provides the insurance company with much of the information it
will need to decide whether to accept or reject the risk.
Return to Top |
|
INDIVIDUAL
DOLLAR-BASED DENTAL INSURANCE
PREMIUM RATES
|
MONTHLY
PREMIUM |
QUARTERLY
PREMIUM |
|
|
Dental Only |
Dental & Vision |
Dental Only |
Dental & Vision |
|
Under Age 18
|
$24.66 |
$27.27 |
$73.98 |
$81.81 |
|
18 through 64
|
$44.99 |
$49.61 |
$134.97 |
$148.83 |
|
65 and over
|
$56.98 |
$62.89 |
$170.94 |
$188.67 |
You
may enroll for Dental Only Coverage or Dental with Vision Coverage.
All
members must be enrolled for the same coverage and premium payment
schedule.
HOW TO APPLY
Please refer to the eligibility section of
this brochure to be sure you meet the eligibility requirements.
|
|
Complete the application in
full. Missing information may cause your effective date to be
delayed. If you have more than four children, please attach
a separate list. |
|
|
Calculate the premium.
Indicate if you are enrolling for the Optional Vision coverage. Be
sure to select a monthly or quarterly payment schedule.
Include the applicable payment for the first month or quarter of
coverage, according to the payment schedule you have selected. |
|
|
You may enroll for Child Only
coverage. If you are enrolling children only, a separate
application must be completed and submitted for each child. |
|
|
If you have any questions,
please call 503-721-7161 or toll-free 1-800-794-5390. |
|
|
Send the application and your
check or money order made payable to Regence Life and Health
|
Insurance Company to:
Regence Life and Health Insurance Company
P0 Box 1271, MS E-3A
Portland, OR 97207-127 1
|
|
Keep this brochure for your records. |
REFUNDS
Return to Top
If you are not satisfied with this Policy, you
may return the policy within 10 days of delivery for a full refund of
premium.
Please note: The application fee of $25 is
non-refundable.
Please read your policy carefully and keep it
available for future reference.
Dental care is
a vital part of maintaining and improving overall health for both
children and adults. It is about more than keeping teeth looking good
Dental disease
is chronic, progressive and, at times, painful. It is also highly
preventable and maintainable with routine care. Routine dental care is
essential for a healthy l~fesiyle which is why Regence Life and Health
s Individual Dollar-Based Dental plan is available to you and your
family.
HOW THE POLICY WORKS
Individual Dollar-Based Dental puts you and your
dentist in control. With this dental plan there are no dental service
limitations or treatment exclusions, except orthodontia, teeth
bleaching and labial veneers. If you engage in your oral health by
receiving a routine exam and cleaning from your dentist during your
benefit year, in the following year Regence Life and Health will
increase the annual benefit maximum. You are in control.
With
the Individual Dollar-Based Dental plan you and your family are free
to visit any dentist. As an added bonus, when you visit one of the
many Regence Life and Health participating dentists you will be
accessing dental providers who have agreed to bill no more than our
allowed amounts for covered procedures.
Incentive: You control your benefit increase by
ieceiving at least
one exam and cleaning in the benefit
year.
|
|
No limitations
or exclusions for
covered services, except orthodontia, teeth |
bleaching and veneers
|
|
Six month
waiting period |
|
|
Optional
Vision Rider available:
$150 in services and/or
hardware every 24 months |
INDIVIDUAL DOLLAR-BASED DENTAL INSURANCE
OUTLINE OF COVERAGE
Return to Top
Read the Policy
Carefully
-
This outline of coverage provides a very brief description of
the important features of the policy. Please note that this outline is
not intended to be a part of the insurance contract. Only the actual
policy provisions are final and binding. The policy itself sets forth
in detail your rights and obligations as well as those of the
insurance company. PLEASE READ THE POLICY CAREFULLY!
ELIGIBILITY
You are eligible for this policy if you and any
family members who apply for coverage are
not covered under any other plan that provides
dental coverage, including any Medicare or
Medicare supplement plan providing dental
coverage.
Important
Note: If we receive notice that a member has become covered
under any other dental coverage, this policys coverage for that
member will be terminated as of the last day of the month (or the
14th day of the month if the
effective date of the policy is the l5th of the month) in which such notice is received.
Eligible dependents include your spouse and your
unmarried dependent children under age 23 who are primarily dependent
on you for support. Any other of your unmarried children under age 23
are eligible if you are legally required to contribute to their
support (unless a court order requires that someone else provide
insurance for them).
Children placed in your custody pending adoption
by you and children related to you by blood or marriage for whom you
are the legal guardian (court order required) will also be considered
eligible dependents.
WAITING PERIOD
This policy has a 6 month benefit waiting period.
The benefit waiting period is the continuous length of time a member
must be covered under the policy before becoming eligible for
benefits.
COVERED SERVICES
Covered Services are those services or supplies that are required to
prevent, diagnose, or treat diseases or conditions of the teeth and
supporting tissues and are dentally appropriate. These services must
be performed by a Dentist or other provider practicing within the
scope of his or her license.
COINSURANCE*
We pay a percentage of the allowed amount as
shown below.
|
50% of the Next |
$400 in Year 1 |
|
|
$900 in Year 2* |
|
|
$1,400 in Year3* |
|
|
$1,900 in Year 4* |
BENEFIT YEAR
MAXIMUM*
$750 in Year
1
$1,000 in Year 2*
$1,250 in Year 3*
$1,500 in Year 4*
*The yearly
maximum will increase only if the member receives at least one
cleaning and exam during the benefit year.
Return to Top
EXCLUSIONS
Your
policy does not cover:
|
|
Orthodontic services, including
craniomandibular orthopedic treatment; procedures for |
tooth movement, regardless of purpose; correction
of malocclusion; preventive orthodontic procedures; and other
orthodontic treatment
|
|
Expenses payable by motor vehicle insurance
or other liability insurance coverage |
OPTIONAL
VISION BENEFITS RIDER
You may elect to include Vision Benefits along
with your dental coverage. The Vision
Benefit pays $150 per member for services and/or
hardware every 24 months.
|
|
INDIVIDUAL INCENTIVE DENTAL INSURANCE
OUTLINE OF COVERAGE
Return to Top
PREMIUM
RATES
|
MONTHLY PREMIUM |
QUARTERLY PREMIUM |
|
|
Dental Only |
Dental & Vision |
Dental Only |
Dental &
Vision |
|
Under Age 18
|
$27.94 |
$30.55 |
$83.82 |
$91.65 |
|
18 through
64 |
$33.66 |
$38.28 |
$100.98 |
$114.84 |
|
65 and over
|
$35.88 |
$41.79 |
$107.64 |
$125.37 |
You may enroll for Dental Only Coverage or
Dental with Vision Coverage. All members must be enrolled for the same
coverage and premium payment schedule.
|
|
Keep this brochure for your records. |
REFUNDS
If you are not satisfied with this Policy, you
may return the policy within 10 days of delivery for a
full refund of premium.
Please note: The application fee of $25
is non-refundable.
Please read your policy carefully and keep it
available for future reference.
Read the Policy
Carefully - This
outline of coverage provides a very brief description of the important
features of the policy. Please note that this outline is not intended
to be a part of the insurance contract. Only the actual policy
provisions are final and binding. The policy itself sets forth in
detail your rights and obligations as well as those of the insurance
company. PLEASE READ THE POLICY CAREFULLY!
ELIGIBILITY
You are eligible for
this policy if you and any family members who apply for coverage are
not covered under any
other plan that provides dental coverage, including any Medicare or
Medicare supplement
plan providing dental coverage.
Important Note:
If we receive notice that a member has become covered under any other
dental coverage, this policys coverage for that member will be
terminated as of the last day of the month (or the
14th1 day of the month
if the effective date of the policy is the 15th of the month) in which
such notice is received.
Eligible dependents
include your spouse and your unmarried dependent children under age 23
who are primarily dependent on you for support. Any other of your
unmarried children under age 23 are eligible if you are legally
required to contribute to their support (unless a court order requires
that someone else provide insurance for them).
Children placed in your
custody pending adoption by you and children related to you by blood
or marriage for whom you are the legal guardian (court order required)
will also be considered eligible dependents.
DEDUCTIBLES
An annual $50
deductible applies individually to each member before benefits are
paid, except that the deductible is waived for cleanings and exams
covered by the policy.
COINSURANCE
After the annual
deductible is met, we pay a percentage of the allowed amount as shown
below. Please note that the coinsurance benefit will increase
only jf the member receives at least one cleaning and exam
each benefit year.
|
Preventive Services |
80% |
90% |
100% |
|
Restorative Services |
60% |
70% |
80% |
|
Major Dental Services |
30% |
40% |
50% |
BENEFIT
MAXIMUM
Return to Top
The maximum benefit
payable each year per member is shown below. Please note that
the benefit maximum will increase only jf the member receives at least
one cleaning and exam each benefit year.
|
YEAR 1 |
YEAR 2 |
YEAR 3 |
YEAR 4 |
|
$750
|
$1,000 |
$1,250 |
$1,500 |
COVERED SERVICES
Covered Services are
those services or supplies that are required to prevent, diagnose, or
treat diseases or conditions of the teeth and supporting tissues and
are Dentally Appropriate. These services must be performed by a
Dentist or other provider practicing within the scope of his or her
license.
Subject to the
limitations and conditions described in the policy, the following will
be considered covered services under your policy:
Preventive and
Diagnostic Services
|
|
Cleanings allowed two per benefit year (includes cleanings and
periodontal |
maintenance)
|
|
Oral
exams allowed two per benefit year |
|
|
Fluoride Treatment allowed two applications per benefit year for
members age 17 |
and under
|
|
X-rays bitewings: allowed one set limited to twice per benefit
year; panoramic and |
full mouth series:
limited to once every three years
|
|
Sealants allowed for permanent bicuspid and molars for members age
17 and under |
|
|
Space Maintainers allowed for members age 11 and under
|
Restorative Services
|
|
Fillings composite and amalgam |
|
|
Emergency treatment for pain relief only |
|
|
Oral
surgery including surgical extractions, removal of teeth, biopsies
and incision and drainage |
|
|
General anesthesia or intravenous sedation allowed for surgical
extractions of teeth and for members age 6 and under |
Major Services
Return to Top
|
|
Crowns or onlays and related services |
|
|
Bridges (fixed partial dentures) limited
to one in a 7-year period
|
|
|
Dentures (full or partial) and related services |
|
|
Endosteal Implants and related services
implants are limited to 4 per lifetime per member |
|
|
Endodontics including root canal
treatment, pulpotomy, apicoectomy
|
|
|
Periodontal Maintenance allowed two per
benefit year (includes cleanings and periodontal maintenance) |
|
|
Gingivectomy and gingivoplasty allowed
once every three years per quadrant
|
|
|
Osseous and mucogingival surgery allowed
once every five years per quadrant
|
|
|
Debridement allowed once every 3 years
|
|
|
Scaling and root planing allowed once
every two years per quadrant
|
Replacement of prosthetics is limited to once in a seven year period
from the date of the most recent placement
EXCLUSIONS
Return to Top
Your policy does
not cover:
|
|
Additional procedures to construct new crown under existing
partial denture framework |
|
|
Application of desensitizing resin for cervical aTnd/or root
surface |
|
|
Collection of cultures and specimens |
|
|
Connector bar or stress breaker |
|
|
Cosmetic/Reconstructive Services and Supplies (certain exceptions
apply) |
|
|
Diagnostic casts or study models |
|
|
Endodontic endosseous implants |
|
|
Expenses payable by motor vehicle insurance or other liability
insurance coverage |
|
|
Exfoliate cytology sample collection or brush biopsy |
|
|
Hospitalization for dentistry |
|
|
Implant maintenance procedures, including: removal of prosthesis,
cleansing of prosthesis and abutments, reinsertion of prosthesis |
|
|
Incision and drainage of abscess extraoral soft tissue,
complicated or non-complicated |
|
|
Interim partial or complete dentures |
|
|
Local anesthesia, sterilization, and supplies billed as separate
charges (these procedures are considered inclusive of billed
procedures) |
|
|
Localized delivery of antimicrobial agents via a controlled
release vehicle into diseased crevicular tissue per tooth |
|
|
Maxillofacial prosthetic procedures |
|
|
Military Service Related Conditions: Any condition resulting from
military service in the armed forces of any country |
|
|
Modification of removable prosthesis following implant surgery |
|
|
Occlusal analysis and adjustments |
|
|
Oral
hygiene instructions |
|
|
Oral/facial photographic images |
|
|
Orthodontic services, including craniomandibular orthopedic
treatment; procedures for tooth movement, regardless of purpose;
correction of malocclusion; preventive orthodontic procedures; and
other orthodontic treatment |
Return
to Top
|
|
Pin retention in addition to restoration |
|
|
Prescription drugs, including take home
prescription drugs, pre-medications, therapeutic drug injections,
or supplies |
|
|
Radical resection of maxilla or mandible |
|
|
Radiographic/surgical implant index |
|
|
Removal of nonodontogenic cyst, tumor or
lesion |
|
|
Replacement of lost, stolen or broken dental
appliances |
|
|
Self-Help, Non Dental Self-Care, Training, or
Instructional Programs |
|
|
Services and Supplies provided by a Family
Member: Services and supplies provided to a member by an immediate
family member |
Return to Top
|
|
Surgical procedures for isolation of a tooth
with rubber dam |
|
|
Tooth transplantation (includes
reimplantation from one site to another and splinting and/or
stabilization) |
|
|
Treatment of simple or compound fractures of
the mandible |
|
|
Treatment of Temporomandibular Joint
Dysfunction |
|
|
Unspecified implant procedures |
OPTIONAL VISION BENEFITS RIDER
You may elect to include Vision Benefits along
with your dental coverage. The Vision
Benefit pays $150 per member for services and/or hardware every 24
months
HOW TO APPLY
Return to Top
Please refer to the eligibility section of
this brochure to be sure you meet the eligibility requirements.
|
|
Complete the application in full.
Missing information may cause your effective date to be delayed.
If you have more than four children, please attach a separate list |
.
|
|
Calculate the premium. Indicate if you are
enrolling for the Optional Vision coverage. Be sure to select a
monthly or quarterly payment schedule. Include the applicable
payment for the first month or quarter of coverage, according to
the payment schedule you have selected. |
|
|
You may enroll for Child Only coverage. If
you are enrolling children only, a separate application must be
completed and submitted for each child. |
|
|
If you have any questions, please call
503-721-7161 or toll-free 1-800-794-5390. |
|
|
Send the application and your check or money
order made payable to Regence Life and Health |
Return to Top
Insurance Company to:
Regence Life and Health Insurance Company
P0 Box 1271,MSE-3A
Portland, OR 97207-1271
|
|
