This is the tri-fold version of the DVH Select brochure. This version is a great leave behind for dentist offices.
Dental, Vision and Hearing Select was designed with you in mind.
This is not a complete disclosure of plan qualifications and limitations. Please access our website to obtain a completed list for the Dental, Vision and Hearing product at disclosure. manhattanlife.com . Please review this information before applying for coverage. The amounts of benefits provided depend on the plan selected. Premiums will vary according to the selection made. Policy Form Numbers: AK7034 (including state variations) Rider Form Numbers: AK7034HR, AK7034VR (including state variations)
Flexability to Choose:
Dental Only
Dental and Vision
This is a Limited Benefit Insurance Policy for Dental, Vision and Hearing Expenses Underwritten by ManhattanLife Insurance and Annuity Company Dental, Vision and Hearing Select
Dental and Hearing
Underwritten by: ManhattanLife Insurance and Annuity Company 10777 Northwest Freeway, Houston, TX 77092 Toll Free Telephone: 800-669-9030
Dental, Vision and Hearing
NOT AVAILABLE IN ALL STATES. DVHS-BRF_0624
The Importance of Dental | Vision | Hearing • Financial protection in unforeseen situations that are painful, inconvenient, and expensive • Basic Medicare does not cover dental, vision or hearing expenses PRODUCTS HIGHLIGHTS • Choose your dentist (in network or out of network) • Family Rates (include up to 3 children) • Individual 18 - 99 • $1,000 - $5,000 policy year benefit option available • Guaranteed Issue • Guaranteed renewable for life* • Orthodontia Benefit • $0 or $100 deductible (does not apply to Preventive Services) * Subject to our right to change premiums. NEW! Careington Network Clients can now access the Careington Maximum Care PPO Dental Network. Use of network completely optional. • Policyholders can now use, if they choose, a dental provider from the Careington Dental network. • Policyholders can also use the dentist of their choice, even if not part of the dental network. • Network discounts may help extend the policy year maximum with reduced charges. • Careington can be contacted at (800) 290-0523.
Vision Rider Vision Services Eye exam, single lenses, trifocal lenses, refraction, bifocal lenses, and progressive lenses
PLAN BENEFITS 1
60% of UCR 1 st yr. 70% of UCR 2 nd yr. 80% of UCR thereafter 1 per year
Eligibility
Anyone age 18 - 99
Policy Year Maximum Benefit
$1,000, $1,500, $3,000 or $5,000
Eyeglass Frame 3 & Contact Lenses
$0 or $100 per person (does not apply to Preventative Services)
$200 maximum per year
Policy Year Deductible
Anti-Reflective Lenses
$45; 1 per year
Dental Coverage Preventive Services Semi-Annual exams, cleaning and x-rays
In-Network: 100% of contracted rate Out-of-Network: 80% of UCR
Polycarbonate Lenses
$40; 1 per year
Contact Lens Fitting Fee
$15; 1 per year
In-Network: 65% of contracted rate 1 st yr. 80% thereafter
Hearing Rider Hearing exam, hearing aid and necessary repairs or supplies 4 3 6 Month Waiting Period 4 12 Month Waiting Period
Basic Services Including x-ray, fillings and extractions (other than “full mouth”)
Out-of-Network: 65% of UCR 1 st yr. 80% thereafter
$750 maximum (per ear, per year)
In-Network: 20% of contracted rate 1 st yr. 50% thereafter
Major Services Including bridges, crowns, full dentures or partials, full mouth extractions, and root canals
Out-of-Network: 20% of UCR 1 st yr. 50% thereafter
Scan to view the full brochure:
In-Network: 65% of contracted rate 1 st yr. 80% thereafter
All Other Medically Necessary Devices (services not listed above)
Out-of-Network: 65% of UCR 1 st yr. 80% thereafter
In-Network: Year 1 - N/A Year 2+ - 50% Out-of-Network: N/A
Orthodontia 2 Straightening of teeth (for all ages) with a lifetime max of $1,500 2
1 Refer to your policy for a complete description of limitations and exclusions. 2 12 Month Waiting Period
Page 1 Page 2Made with FlippingBook - Share PDF online