LifeMap Incentive 10 Dental Plan

LifeMap

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Individual Incentive 10 Dental rewards you for receiving routine preventive care. Each year that you visit the dentist for an annual exam and cleaning means greater benefits and fewer out-of-pocket expenses the next year

Dental Plan features:

  • Six-month waiting period for restorative services and
    12-month waiting period for major services
  • Deductible waived for exams and cleanings covered under Preventive Services
  • $50 deductible for other covered services
  • The ability to choose any dentist but save even more by choosing a Regence network provider (find a network provider at www.LifeMapCo.com)
  • Optional vision rider available (reimburses up to $150 in vision services and/or hardware per member every two years)

Here’s how it works:

When you get your teeth cleaned and examined every year, you’re rewarded with greater benefits the next year. Watch your annual benefits increase and your out-of-pocket coinsurance decrease.

By year four, you can reach a maximum annual benefit of $1,500. And the percentage the plan pays in coinsurance can increase to 100/80/50 by year three. This means we’ll pay 100% of preventive care, such as routine cleanings; 80% of restorative care, such as fillings; and 50% of major dental care like crowns or root canals

 Individual Incentive 10 Dental Benefits

 

Outline of Coverage: Individual Incentive 10 Dental

Covered services are those dentally appropriate services or supplies that are required to prevent, diagnose or treat diseases or conditions of the teeth and supporting tissues. 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 Services

  • Cleanings, limited to two per benefit year, whether they’re considered cleanings or periodontal maintenance (periodontal maintenance covered under major services)
  • Oral exams allowed, two per benefit year
  • Fluoride treatment: two applications per benefit year for members age 17 and under
  • X-ray bitewings: one set limited to twice per benefit year; panoramic and full-mouth series: limited to once every three years
  • Sealants allowed for permanent bicuspids 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 extraction of teeth and for members age six and under
  • Direct pulp capping

Major Services

  • Crowns or onlays and related services
  • Bridges (fixed partial dentures)
  • Dentures (full or partial) and related services
  • Endosteal implants and related services; implants are limited to four per lifetime per member
  • Endodontics, including root canal treatment, pulpotomy and apicoectomy
  • Periodontal maintenance, limited to 2 per benefit year in lieu of preventive cleaning.
  • Scaling and root planing allowed once every two years per quadrant
  • Debridement allowed once every three years
  • Gingivectomy and gingivoplasty allowed once every three years per quadrant
  • Osseous and mucogingival surgery allowed once every five years per quadrant

Replacement of prosthetics is limited to replacements made at least seven years from the most recent placement; limited to once in a seven year period.

Exclusions

Click here for Individual Incentive 10 Dental Policy Exclusions.

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