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Individual Incentive Dental Plan
Imagine dental coverage that increases as you are proactive about visiting the dentist. That's the idea behind
Individual Incentive Dental—offering financial rewards for an annual checkup and cleaning.
Plan features:
- No waiting period
- Deductible waived for exams and cleanings
- $50 deductible for other covered services (see below)
- Choose any dentist, but save even more by using one of our network providers
- Optional Vision rider available ($150 in services and / or hard-ware per Member every two years)
Here's how it works:
Have your teeth cleaned and examined every year and get rewarded with greater benefits the next year. Watch your annual
benefits increase and your out-of-pocket expenses for co-insurance decrease. By year four, you can reach a maximum annual
benefit of $1,500. And the percentage the plan pays in coinsurance increases to 100/80/50 by year three. This means we will
pay 100% of preventive care, such as routine cleanings; 80% of restorative care, such as fillings; and 50% of major dental
care like crowns or root canals.
Outline of Coverage
Covered Services
Covered Services are those services or supplies that are required to prevent, diagnose, or treat diseases or conditions
of the teeth and supporting tissues and are Dentally Appropriate. These services must be performed by a Dentist or other
provider practicing within the scope of his or her license. Subject to the limitations and conditions described in the
policy, the following will be considered covered services under your policy.
Preventive and Diagnostic Services
- Cleanings, limited to 2 per benefit year in lieu of periodontal maintenance. Periodontal mantenance are covered
under major services.
- Oral exams allowed, two per benefit year
- Fluoride Treatment allowed two applications per benefit year for members age 17 and under
- X-ray bitewings: allowed one set limited to twice per benefit year, panoramic and full mouth series: limited to
once every three years
- Sealants allowed for permanent bicuspids and molars for members age 17 and under
- Space Maintainers allowed for members age 11 and under
Restorative Services
- Fillings, composite and amalgam
- Emergency treatment for pain relief only
- Oral surgery including surgical extractions, removal of teeth, biopsies and incision and drainage
- General anesthesia or intravenous sedation allowed for members age 6 and under or members who are physically
or developmentally disabled.
- Direct pulp capping
Major Services
- Crowns or onlays and related services
- Bridges (fixed partial dentures)
- Dentures (full or partial) and related services
- Endosteal Implants and related services; implants are limited to four per lifetime per member
- Endodontics including root canal treatment, pulpotomy, apicoectomy
- Periodontal maintenance, limited to 2 per benefit year in lieu of preventive cleaning.
- Scaling and root planing allowed once every two years per quadrant
- Debridement allowed once every three years
- Gingivectomy and gingivoplasty allowed once every three years per quadrant
- Osseous and mucogingival surgery allowed once every five years per quadrant
Replacement of prosthetics is limited to replacements made at least seven years from the most recent placement; limited to once in a seven year period.
Exclusions
Click here for Individual Incentive Dental Policy Exclusions.
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E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
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