Time Insurance Company
Dental Plus Plan
Schedule of Covered Services and Copayments
Time Insurance Company Plus Plan is a simple, affordable plan for good health. Regular dental care can mean more than a brighter smile – it could also mean better overall health. Dental Coverage pays cash benefits when you have dental checkups and treatment – making it easier to keep up with regular visits to the dentist and lead a healthier life. You will get a set cash amount for each dental treatment such as an extraction or a filling, there is no waiting period for checkups and you can visit any dentist of your choice – no network restrictions.
Click here to see the Plus Plan Brochure.
|Schedule of Covered Services and Copayments|
|THIS CHART IS ONLY A SUMMARY. For a complete list of the benefits, exclusions, and limitations, please refer to the Explanation of Benefits (EOB) in your Enrollment Packet.|
(No Waiting Period)
|Includes: cleanings, exams, x-rays, fluoride and sealants. Two visits per person each policy year, separated by at least 150 days.||$100/visit|
(No Waiting Period)
In the first policy year, payments are 50% of the per-service benefit. After the first year, payments are 100% of the per-service benefit.
|Anesthesia||$70 – $275/service|
|Extractions||$80 - $100/service|
|Denture Adjustment and Repair||$55 - $350/service|
Major 180 day waiting period (except KS)
After the waiting period, payments are 50% of the per-service benefit for the remainder of the first policy year. After the first year, payments are 100% of the per-service benefit.
|Inlay/Onlay||$20 - $375/service|
|Crowns||$40 - $450/service|
|Endodontics||$30 - $400/service|
|Periodontics||$30 - $325/service|
|Dentures||$275 - $400/service|
|Fixed prosthodontics||$175 - $375/service|
|Oral Surgery||$75 - $1,000/service|
|Annual Maximum||The maximum calendar year benefit. Preventive services benefits do not take away from Basic and Major services benefits.||$1,500/year for Basic and Major services combined|