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How to use your Dental plan

Maximum Care PPO

National General Accident & Health Dental PPO plans help you pay for the dental care you need and gives you access to the Careington Maximum Care Dental Network.

With this plan, you get benefits for Preventive, Basic and Major services. If you've gone to a dentist to get your teeth cleaned, then you've received Preventive services before.

Here are some examples of what's covered under of each category:

Preventive:
Evaluations, examinations, cleanings, fluoride treatments and x-rays

Basic:
Emergency treatment of dental pain, deep sedation/ general anesthesia for basic services, consultations, amalgam and resin-based composite fillings, denture adjustments and repairs, denture rebase and reline, and extractions

Major (not covered under the Essentials level plan):
Deep sedation/ general anesthesia for major services, inlay/onlay restorations, crowns (single restoration only), endodontics, surgical periodontal services, and dentures

With this plan, there is no waiting period for preventive care, and preventive care is covered at 100% with no deductible - no matter which plan level you selected.

Here's how the plan pays for dental services:

Essentials

Essentials Plus

Enhanced

Annual Deductible
Deductible does not apply to preventative services
$50/Individual
$150/Family
$50/Individual
$150/Family
$50/Individual
$150/Family
Annual Coinsurance
What this plan pays for each covered service
Preventive 100%
Basic 70%
Major 0%
Preventive 100%
Basic 70%
Major25%
Preventive 100%
Basic 80%
Major 50%
Annual Maximum Benefits $1,000/person $1,250/person $2,000/person
Waiting Periods Preventive: 0 Months
Basic: 6 Months
Major: No Coverage
Dentures: No Coverage
Preventive: 0 Months
Basic: 6 Months
Major: 12 Months
Dentures: 18 Months
Preventive: 0 Months
Basic: 6 Months
Major: 12 Months
Dentures: 18 Months

How does this plan work? Let's do some math:

The average price of a Composite filling is $201*. If you use a Careington Network dentist, you can reduce that cost to $101**. Once your Dental PPO Essentials Plus plan pays benefits, you are responsible for the remaining $65.30.

Estimated treatment cost: $201
Cost with Network Discount: $101
Dental PPO Plan pays 70%: - $35.70
Total cost to you, including your annual $50 deductible: $65.30

In this example, your Dental benefits and network discount reduced the cost of your dental care by 70%. Now that's something to smile about.

* Regular cost is based on the national average of the 80th percentile usual and customary rates as detailed in the 2015 FairHealth Report in the Los Angeles, Orlando, Chicago and New York City metropolitan statistical areas.

** These fees represent the average of the assigned Maximum Care (DN14) fees in the Los Angeles, Orlando, Chicago and New York City metropolitan statistical areas.

Example provided for illustration purposes only. Prices are subject to change.

This is a PPO plan. This is not a discount plan.
Third party administrators will pay for covered services according to the plan design. All applicable co-pays, deductibles or co-insurance, outlined by the plan design, are to be paid directly to the dental office at the time service is rendered. Please ask the dentist or office staff to explain all charges before treatment begins.

DN11