Agent Guide | Dental, Vision & Hearing
ManhattanLife Insurance and Annuity Company
Product Benefits
PLAN BENEFITS DVH
DVH Select
Issue Ages
Individual (18 - 85) / Children (3 - 17) $1,000, $1,500, $3,000 or $5,000
Individual (18 - 99) / Children (3 - 17) $1,000, $1,500, $3,000 or $5,000 $0 or $100 per person (does not apply to Preventative Services)
Policy Year Maximum Benefit
$100 per person
Policy Year Deductible
Network
Careington Network
Careington Network
Guaranteed Issue
Yes Yes
Yes Yes
Guaranteed Renewable
In-network benefits will be charged a discounted fee/contracted fee for covered services Out-of-network benefits will be covered a percentage of UCR
In-network benefits will be charged a discounted fee/contracted fee for covered services Out-of-network benefits will be covered a percentage of UCR
Network Charges Exhibit
DENTAL COVERAGE*
In-Network
Out-of-Network
Year 1 - 60% Year 2 - 70% Year 3 and thereafter - 80% Year 1 - 60% Year 2 - 70% Year 3 and thereafter - 80% Year 1 - 0% Year 2 - 70% Year 3 and thereafter - 80%
100% of contracted rate 65% of contracted rate 1st yr. 80% thereafter 20% of contracted rate 1st yr. 50% thereafter 20% of contracted rate 1st yr. 50% thereafter
Preventative Services
80% of UCR
65% of UCR 1st yr. 80% thereafter
Basic Services
20% of UCR 1st yr. 50% thereafter
Major Services 1
20% of UCR 1st yr. 50% thereafter
All Other Medically Necessary Services (services not listed above)
N/A
Year 1 - N/A Year 2+ - 50%
Orthodontia2
N/A
N/A
VISION COVERAGE**
60% of UCR 1st yr. 70% of UCR 2nd yr. 80% of UCR thereafter 1 per year $200 maximum per year
Vision Services 3
Year 1 - 60% Year 2 - 70% Year 3 and thereafter - 80% HEARING COVERAGE** Year 1 - 60% Year 2 - 70% Year 3 and thereafter - 80%
• Eye Exam • Single Lenses • Trifocal Lenses
• Refraction • Bifocal Lenses • Progressive Lenses
• Eyeglasses Frame 4
• Contact Lenses
Hearing Services • Hearing Exam • Hearing Aid and Necessary Repairs or Supplies 5
$750 maximum (per ear, per year)
¹ For DVH7016 - 12 Month Waiting Period; 2 For DVH Select - lifetime maximum is $1,500; 3 For DVH Select only - Anti-Reflective Lenses, Polycarbonate Lenses Contact Lens Fitting Fee are in included, see policy for coverage amounts; 4 For DVH7016/DVH Select - 6 Month Waiting Period; 5 For DVH Select - 12 Month Waiting Period. * Full listing of Dental Coverage on next page ** For DVH7016 coverage is included (except in FL, they are available as riders) ** For DVH Select coverage are riders (for DVH Select in NM, Vision and Hearing riders are unavailable)
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AGT-DVH_1125
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