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Advantage DentalThe chart below illustrates plan reimbursements and provides some examples of coverage. This plan covers ANY dental service that has an American Dental Association code and is performed by a licensed Dentist or Denturist. Click Here To Apply | Policy Year Covered charges | Percent covered | Benefit payment | | Year 1 | | | $0-$200* | 100% | $200 | $200-$500 | 80% | $240 | $500-$1020 | 50% | $260 | Maximum Policy Year Benefit | $700 | | Year 2 | | | $0-$200* | 100% | $200 | $200-$600 | 80% | $320 | $600-$1560 | 50% | $480 | Maximum Policy Year Benefit | $1,000 | | Year 3+ | | | $0-$200* | 100% | $200 | $200-$700 | 80% | $400 | $700-$2500 | 50% | $900 | Maximum Policy Year Benefit | $1,500 | | | *Deductible: A deductible applies to services performed by non-member dentists. The deductible is $100 per policy year. Example #1:
During the first year of coverage you go to a member dentist twice. The first time, the charges are $180. The second time, the charges are $250. Advantage Dental Plan will pay 100% of the first visit, or $180. The second visit, Advantage Dental Plan will pay 100% of the first $20 and 80% of the remaining $230, for a total of $204. Example #2:
During the second year of coverage you see a non-contracted dentist, and the charges are $875. Advantage will pay 100% of the first $200 dollars after the $100 deductible. Advantage will pay 80% up to $600 or $320. The last $175 will be paid at 50%, or $87.50. |
| Sample EOB (Example #2) | | | Total Services as billed by Dentist | 875.00 | | - Minus deductible | -100.00 | | Services after deductible | 775.00 | | - First $200 paid at 100% | 200.00 | | - Next $400 paid at 80% | 320.00 | | - Last $175 paid at 50% | 87.50 | | Total Paid by ADP | 607.50 | | Patient Responsibility | 267.50 |
Example #3:
During the first year of coverage, you see a contracted dentist, and the charges are $200. Later that year, you see a non-contracted dentist and the charges are $500. Advantage will pay 100% of the first $200 dollars. You must pay the first $100 of the charge for the second visit because it was to a non-contracted dentist. Advantage will pay 80% of the $300, and 50% of the balance. Sample EOB (Example #3) | | Total Services as billed by Dentist #1 | 200.00 | | - No deductible | 0.00 | | Services after deductible | 200.00 | | - First $200 paid at 100% | 200.00 | | Total Paid by ADP | 200.00 | | Patient Responsibility | 0.00 |
| Sample EOB (Example #3) | | | Total Services as billed by Dentist #2 | 500.00 | | - Minus deductible | -100.00 | | Services after deductible | 400.00 | | - First $300 paid at 80% | 240.00 | | - Next $100 paid at 50% | 50.00 | | Total Paid by ADP | 290.00 | | Patient Responsibility | 210.00 |
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