Schedule of Covered Services and Copayments
The Nationwide Classic Select 2000 plan is a comprehensive dental insurance plan created to offer you and your qualified family members the protection and flexibility you need to maintain your winning smile.
When you enroll with Nationwide Multifelx Dental, you receive affordable coverage for basic, preventive, and major dental services. Since you will be automatically accepted, your coverage begins the month after your application is received. This plan offers the use of Maximum Care, a national, seamless, credentialed PPO dental network, ranked in the top ten for network size. Maximum Care dentists offer fees below normal costs. The Classic Select 2000 plan gives you the freedom to select any dentist you please, but if you use the Maximum Care network and you choose a dentist in the network, you may receive cost savings on fees to you and your family.
Out-of-Network benefits will be paid based on MAC fees. MAC means the Maximum Allowable Charge for your plan. You may be responsible for the difference between the MAC and the actual dental charge from a Non-Participating Provider.
|Schedule of Covered Services and Copayments|
|*Deductible is waived if In-Network is used.|
|In Network||Out of Network|
No waiting periods
|Routine oral exam, Bitewing, Prophylaxis, Sealant, Space Maintainer, Topical Application of Fluoride||100%||70%|
6 month waiting period
|Full mouth X-ray, Fillings, Simple extractions||80%||70%|
18 month waiting period
|Crowns, bridges, onlays, pontics, oral surgery (surgical extractions & impactions), endodontics, periodontics, dentures.||60%||50%|
|Dental Deductible||Per calendar year, per insured person, Combined In-Network and Out-of-Network||$50 Individual
|Maximum Plan Benefit||Per calendar year, per insured person||$2,000|