Name: Premier Select 1500
Brand: Nationwide

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person 90001 | Applicant,35 edit

$51.03 /mo.

Dentist Search

Premier Select 1500

Plan Type PPO

Dentist Search

$51.03 /mo.

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Plan Highlights

Freedom to choose any dentist, but using Maximum Care Network will give you in-network benefits
Maximum Care network a national, seamless, credentialed PPO dental network, ranking in the top 10 for network size
Coverage for you and qualified family members
Coverage for preventive, basic and major services
No Waiting Periods for preventive and basic services
Guaranteed acceptance
Low deductible limits
Coverage is offered to individuals under 65 years of age plus their eligible dependents. For individuals age 65 years and older plus their eligible dependents coverage is offered at an increased rate. Your rate will be automatically adjusted on the month of your 65th birthday

Common Procedures

Details

Fee Schedule: N/A | Dentist Search

Exams: Routine periodic examinations – twice in a calendar year
In Network – 100% after deductible
Out of Network – 70% of Maximum Allowable Charge after deductible
Preventive – No waiting period

Cleanings: Cleanings – twice in a calendar year
In Network – 100% after deductible
Out of Network – 70% of Maximum Allowable Charge after deductible
Preventive – No waiting period

X-Rays: Radiography:
Full mouth X-rays
In Network – 80% after deductible
Out of Network – 70% of Maximum Allowable Charge after deductible
Basic – No waiting period

Fillings: Fillings:
Restorative Amalgam Fillings
Resin-based composite (white fillings) anterior only
In Network – 80% after deductible
Out of Network – 70% of Maximum Allowable Charge after deductible
Basic – No waiting period

Extractions: Simple Extractions
In Network – 80% after deductible
Out of Network – 70% of Maximum Allowable Charge after deductible
Basic – No waiting period

Crowns: In Network – 60% after deductible
Out of Network – 50% of Maximum Allowable Charge after deductible
Major – 12 months waiting period

Root Canals: Endodontics:
Pulpal therapy and root canals
In Network – 60% after deductible
Out of Network – 50% of Maximum Allowable Charge after deductible
Major – 12 months waiting period

Dentures: In Network – 60% after deductible
Out of Network – 50% of Maximum Allowable Charge after deductible
Major – 12 months waiting period

Deep Cleanings: Treatment of diseases of the gums
In Network – 60% after deductible
Out of Network – 50% of Maximum Allowable Charge after deductible
Major – 12 months waiting period

Implants: Not Covered Service

Braces / Orthodontia: Not Covered Service

Teeth Whitening: Not Covered Service

Additional Network Information:

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 Premier Select 1500 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.

Exclusions and Limitations
Privacy Policy
Plan Brochure

FAQ

Can I change my dentist once I am in the plan?

Yes, you may change your dentist at any time.

What is a pre-existing condition versus work-in-progress? Is it covered?

What provider options do I have?

When can I start using my Plan?

When will I receive my new member kit and what will it include?

Who can enroll in this plan?

Nationwide Life Insurance Company
One Nationwide Plaza
Columbus, Ohio 43215-2220

Disclaimers & Disclosures

This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.

Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.

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