DENTAL PLANS
SUMMARY OF COVERAGE
P5284 Plan
In Network
Out of Network
100% Coverage
100% After Deductible
Type I – Preventive Services Cleanings for Children under the age of 18; Flouride Treatments, Sealants, Space Maintainers
80% Coverage
80% After Deductible
Type II – Basic Services Restorations, General Services, Simple Extractions
50% Coverage
50% After Deductible
Type III – Major Services Oral Surgery, Endodontics, Periodontics, Inlays, Onlays, Crowns, Dentures, Bridges
N/A
100% After Deductible
Type IV – Orthodontics
Calendar Year Deductible Waived for Preventive Services
Yes $50
Yes $50 $150
Individual
$150
Family
Maximum Benefit Limits Annual Limit
$1,000
$1,000
10
I
Hometown Veterinary Partners Benefits Guide
DENTAL PLAN
10
Made with FlippingBook - professional solution for displaying marketing and sales documents online