 -- -- -- |
Usual Fee | Member Charge |
|---|---|---|
| Cleanings | $ 41.00 | No Charge |
| X-Rays | 56.00 | No Charge |
| Examinations | 30.00 | No Charge |
| Amalgam Fillings (After 1st Year) | 44.00 | No Charge |
| Simple Extractions (2) | 61.00 | No Charge |
| Single Root Canal | 303.00 | $150.00 |
| Crown (Porcelain/Semi-precious Metal) |
505.00 | 275.00 |
| Denture | 660.00 | 275.00 |
2. Does my Whole Family Have to go to the Same Dentist?
No, each member of your family may choose a participating dentist that is convenient for them.
3. Can I Change my Dentist if I Move?
Yes, but please notify United Dental Care first so we can notify both offices of the change.
4. What if I must see a Specialist?
You must be referred to an United Dental Care specialist by your general dentist. In most cases, arrangements have been made for you to receive a 25% reduction from the participating specialist's usual and customary fees.
5. What if I am Away from Home and Require Emergency Dental Treatment?
If you are more than 50 miles away from your residence and a participating dental office is not available, you will be covered for emergency dental treatment up to $100.00 per year. Pay for your treatment, then send United Dental Care the bill. We will reimburse you.
6. Can I Cover my Dependents?
Yes, eligible dependents include your spouse, unmarried children under 19 years of age, and dependent children up to age 25 under certain conditions. Proof of such dependency must be submitted to United Dental Care within 31 days of the dependent's attainment of age 19.
7. When will Benefits Begin?
Your application, dental office selection and payment must be received by the 15th to be effective the first of the following month. You will then receive a personal membership card and Plan Booklet with your Agreement and full plan description.
8. How Do I Enroll?
Simply fill out Walling Insurance Services, Inc.'s Dental Form and a member of our staff will contact you with information about enrolling in United Dental Care' Individual Family Dental Plan!
9. What Does it Cost and How Do I Pay?
| ------ |
*Monthly | Annually |
|---|---|---|
| Member | $10.95 | $119.40 |
| Member and 1 Dependent | 16.75 | 189.00 |
| Member and 2 Dependents | 20.75 | 237.00 |
| Member and 3 Dependents | 23.50 | 270.00 |
| Member and 4 Dependents | 27.50 | 318.00 |
| Member and 5 or More Dependents (*Includes a Monthly Service Charge of $1.00) |
32.00 | 372.00 |
| One-time Only Enrollment Fee (Non-refundable) |
30.00 | 30.00 |
10. What are the Vision Plan Benefits?
11. What are the Plan Limitations and Exclusions?
The following items are excluded:
1. Services for injuries or conditions which are covered under Workman's Compensation or Employer's Liability Laws. Services which are provided without cost to the member by any municipality, county or other political subdivision.
2. Cost of dental care which is covered under automobile, medical and no-fault or similar type insurance.
3. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health.
4. Cosmetic, elective or aesthetic dentistry.
5. Oral surgery requiring the setting of fractures or dislocations.
6. Treatment of malignancies, cysts or neoplasms, or congenital malformities.
7. Dental procedures performed in a hospital.
8. Any dental implants or experimental procedures, and/or procedures not generally performed in general dental offices.
9. General anesthesia.
10. Services that cannot be performed because of the general health of the patient.
11. Services performed by a non-participating dentist except in the case of emergency within 50 miles of patient's home.