Connect With Us
Call (317) 348-1845 for more information and enroll today!
MAX Choice Plus Plan
|Diagnostic & Preventive Services|
|Diagnostic and Preventive Services - Includes exams and cleanings twice per year, bitewing X-rays and fluoride treatments to age 14||80%||60%|
|Brush Biopsy - Used to detect oral cancer||80%||60%|
|Radiographs/diagnostic imaging* - X-rays||60%||60%|
|Emergency palliative treatment||60%||40%|
|Periodontic Services - Treatment for diseases of the gums and supporting structures of the teeth||60%||40%|
|Oral surgery services - Extractions and dental surgery, including local anesthesia, suturing and post-operative care||60%||40%|
|Minor restorative services - Silver and white fillings||60%||40%|
|Other basic services - Misc. services||60%||40%|
|Endodontic services - Root canals||40%||20%|
|Major restorative services - Crowns||40%||20%|
|Prosthodontic Services - Bridges, dentures and implants||40%||20%|
|Denture and bridge repairs and relines||40%||20%|
|Orthodontic services* - Braces||50%||50%|
|Orthodontic age limit||19||19|
|Maximums and Deductibles|
|Contract year maximum||$1,300 per member||$1,300 per member|
|Orthodontic lifetime maximum||$1,500 per member||$1,500 per member|
|Deductible (per contract year)
*Deductible waived for these services
|$50 per member/ $150 per family||$50 per member/ $150 per family|
|Allowed Amount||PPO Fee||80th percentile|
|Waiting Periods - Basic Services will not be covered until after a person is enrolled in the dental plan for 6 consecutive months. Major Services will not be covered until after a person is enrolled in the dental plan for 12 consecutive months. Orthodontics will not be covered until after a person is enrolled in the dental plan for 24 consecutive months.|
NOTES: The above summary is a sample of benefits. Policies have exclusions and limitations that may limit coverage. For complete coverage details, please refer to your policy.
Exclusions: Charges or treatment for correction of congenital or developmental malformations or dentistry for aesthetic reasons; general anesthesia and/or intravenous sedation; cosmetic surgery (except reconstructive surgery for children because of congenital disease or anomaly); treatment by anyone other than a licensed dentist or dental hygienist; veneers, sealants, prosthodontics (implants), prefabricated crowns as final restoration on permanent teeth and paste-type root canal fillings on permanent teeth; appliances, procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Policy and/or Summary of Dental Plan Benefits.
Limitations: Coverage for services may be limited based on the age of the person receiving services; coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years); coverage for temporomandibular disorders (TMD) is limited.
The premium rate will vary between plans. The policy has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with the policy provisions. Coverage may be terminated for reasons stated in the policy. Coverage ceases upon termination of the policy. Products and services referred to in this brochure may not be available in all states or jurisdictions. Underwritten by Renaissance Life & Health Insurance Company, Indianapolis, IN, and in New York by Renaissance Health Insurance Company of New York, New York, NY. Both companies may be reached at PO Box 1596, Indianapolis, IN 46206.
*Renaissance Internal Data, 2016
© 2016 Renaissance Holding Company | All Rights Reserved | PO Box 1596, Indianapolis, IN 46206-1596
Underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN and in New York by Renaissance Life & Health Insurance Company of New York, Binghamton, NY. Each company has sole financial responsibility for its own products. Products and services referred to are not available in all states and jurisdictions.