Nationwide
Premier Select 1500
- 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: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 80% |
| Crown: | 60% |
| Root Canals: | 60% |
| Simple Extractions: | 80% |
| Plan Maximum: | $1500 per calendar year, per insured person |
| Waiting Periods: | Preventive-None, Basic-None, Major-12 months |
| Deductible: | $100 per person / $300 per Family for Preventive, Basic and Major Services |
| 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 LimitationsPrivacy 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?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program. The plan does not cover any expenses prior to the date you are covered under the Policy.
What provider options do I have?
The plan gives you the freedom to select any licensed 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.
When can I start using my Plan?
You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.
When will I receive my new member kit and what will it include?
Your enrollment package will be emailed within 3 days of application approval. The email will contain the web address to go to, along with a username and password to log in and retrieve your enrollment package. It will include a welcome letter, policy, certificate and ID card.
Who can enroll in this plan?
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.
As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.
One Nationwide Plaza
Columbus, Ohio 43215-2220
Disclaimers and Disclosures:
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