This is our latest dental offering which allows the purchase of dental, vision & hearing, dental only, dental and hearing only, or dental and vision only.
This is a Limited Benefit Insurance Policy for Dental, Vision and Hearing Expenses. Dental, Vision and Hearing Select
Underwritten by ManhattanLife Insurance and Annuity Company Not available in all states.
DVHS-BR 0525
The Importance of Dental | Vision | Hearing
• Help maintain quality of life • Financial protection in unforeseen situations that are painful, inconvenient, and expensive • Basic Medicare does not cover dental, vision or hearing expenses
PRODUCTS HIGHLIGHTS • Individual ages 18 – 99 • Family rates (include up to 3 children) • $0 or $100 deductible (does not apply to Preventive Services) • Glasses, Contacts and Hearing Aid benefits • Guaranteed renewable for life* • Choose your dentist (in-network or out-of-network)
• $1,000, $1,500, $3,000, or $5,000 policy year maximum benefit • Orthodontia benefit • No waiting periods for Dental Services (except Orthodontia) • Guaranteed issue
* Subject to our right to change premiums.
Flexibility to choose . . .
+
+
+
+
Dental, Vision and Hearing
Dental Only Dental and Vision
Dental and Hearing
Dental, Vision and Hearing Select from ManhattanLife was designed with you in mind. With the ability to choose specific benefits, you can customize a plan tailored to fit your needs.
Studies suggest that for every dollar spent on preventive dental care, patients can save between $8 and $50 in future dental treatment costs, demonstrating the economic value of regular check-ups. 1 20% of patients with regular dental check-ups reported being “very satisfied” with their dental care, compared to 10% of patients with irregular check-ups, suggesting that regular visits contribute to higher patient satisfaction. 2
1 https://www.dentaltown.com/blog/post/20470/preventive-dentistry-in-focus-key-statistics-and-trends 2 https://pmc.ncbi.nlm.nih.gov/articles/PMC10136530/
Plan Benefits
Eligibility: Ages 18 - 99 Policy Year Maximum Benefit: $1,000, $1,500, $3,000, or $5,000 Policy Year Deductible: $0 or $100 per person (does not apply to Preventative Services)
In-Network
Out-of-Network
Preventive Services • Dental Exams; 2 per year • Cleanings; 2 per year Basic Services • Limited Oral Evaluation • Diagnostic Consultation
100% of contracted rate
• Bitewing X-Rays; 2 per year • Fluoride treatment is for age 16 and under; 2 visits per year
80% of UCR
• Basic Restorative Service
65% of contracted rate 1st yr. 80% thereafter
• Filling • Emergency Palliative Treatment • Basic Oral Surgery • Panoramic X-Ray • Periodontal Service • Periapical X-Ray • Non-Surgical Extraction • Periodontal Non-Surgical Service
65% of UCR 1st yr. 80% thereafter
Major Services • Major Restorative Service
20% of contracted rate 1st yr. 50% thereafter 20% of contracted rate 1st yr. 50% thereafter
20% of UCR 1st yr. 50% thereafter
• Periodontal Service • Prosthodontic Service
• Inlay/Onlay/Crown • Endodontic Service
• Implants 2
20% of UCR 1st yr. 50% thereafter
All Other Medically Necessary Services (services not listed above)
Orthodontia 1 • Straightening of teeth (for all ages) • Lifetime max $1,500 2
Year 1 - N/A Year 2+ - 50%
N/A
1st year: 60% of UCR 2nd year: 70% of UCR Thereafter: 80% of UCR 1 per year $200 maximum per year
Vision Services • Eye Exam • Single Lenses • Trifocal Lenses • Eyeglass Frame 3
• Refraction
• Bifocal Lenses
• Progressive Lenses
• Contact Lenses
• Anti-Reflective Lenses • Polycarbonate Lenses • Contact Lens Fitting Fee
$45; 1 per year $40; 1 per year $15; 1 per year
Hearing Services • Hearing Exam
• Hearing Aid and Necessary Repairs or Supplies 1
$750 maximum (per ear, per year)
1 12 Month Waiting Period; 2 Lifetime Maximum $1,500; 3 6 Month Waiting Period UCR - Usual, Customary and Reasonable (See back page for more details)
CAREINGTON NETWORK* Clients can access the Careington Maximum Care PPO Dental Network. Use of network is completely optional. • Policyholders can benefit from choosing a dental provider from the Careington Dental Network. • Policyholders can also use the dentist of their choice, even if they are 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. We continue our history of “Standing By You” through our partnership with Careington Maximum Care PPO Dental Network. Our partnership provides policyholders access to discounted costs on a wide range of services.
Discounted fees to help your dental benefits go further
Access to quality dentists all around the country
100,000+ Dentists Nationwide
So while you can choose your own dentist, visiting a Careington dental network provider offers greater savings and discounts. Visit h ttps://manhattanlife.solutionssimplified.com/ to find a Careington dentist near you.
*Careington was founded in 1979 by two dentists and is rated A+ with the Better Business Bureau (BBB).
Understanding How Your Benefits Work In-Network
Peter goes to his Careington Network dentist for a regular check-up. Upon examination, the dentist realizes that Peter needs a filling. Luckily, Peter has a Dental Plan with ManhattanLife. He has met his $100 annual deductible. Procedure: Provider Charge In-Network Cost ManhattanLife Pays You Pay Dental Exam $150 $35 100% Preventative day one; $35.00 $0
65% Basic day one; (of In-Network Cost = $64)
$35 ($99 - $64)
Filling
$275
$99
Total
$425
$134
$99
$35
Out-of-Network Peter chose not to use the Careington Network and instead goes to an out-of-network dentist for a regular check- up. Upon examination, the dentist realizes that he needs a filling. Peter has a Dental Plan with ManhattanLife. He has met his $100 annual deductible. Procedure: Provider Charge Out-of-Network Cost* ManhattanLife Pays You Pay Dental Exam $150 $96 80% Preventative day one; (of Usual and Customary = $77) $73 ($150 - $77)
65% Basic day one; (of Usual and Customary = $114)
$111 ($225 - $114)
Filling
$225
$175
Total
$375
$271 $184 *subject to the Usual and Customary charges based in zip code 77092 $191
Earl goes to the Eye Doctor for an eye exam and gets glasses. He has had a Dental + Vision plan with ManhattanLife for over a year and has met his annual deductible. Procedure:* Cost ManhattanLife Pays
You Pay
70% year two $42
Eye exam
$60
$18
$200 maximum; $200
Eyeglass Frame
$250
$50
70% year two $81
Lenses
$115
$34
Total
$425
$323 $102 *subject to the Usual and Customary charges based in zip code 77092
After a 12 month waiting period Brian decides to get his hearing checked, as he’s noticed a progressive hearing decline. His ENT specialist recommends Brian get hearing aids to help relieve the hearing loss. Utilizing the hearing portion of the plan, his exam and devices would have been covered as follows: Procedure:* Cost ManhattanLife Pays You Pay Hearing Exam $90 $750 maximum per ear, per year: $90 $0 Hearing Aids $1,600 $750 maximum per ear, per year: $1,500 - $90 (Hearing Exam) = $1,410 $190 Total $1,690 $1,500 $190 *subject to the Usual and Customary charges based in zip code 77092 *For illustrative purposes only. Claims examples are subject to geographic region, out of network provider and usual & customary charges.
Dental, Vision & Hearing Select Monthly Rates*
DENTAL COVERAGE $1,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$35.36 $38.11 $48.60
$27.93 $29.15 $37.41 $40.12 $42.42 $45.01
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$76.21
$91.14 $138.09
$58.31
$71.05 $107.19
$97.19 $133.95 $164.36
$74.82 $104.25 $127.89
$51.79 $103.56 $124.34 $151.30 $54.61 $109.21 $107.70 $126.90 $58.23 $116.46 $110.73 $125.30
$80.24 $84.85 $90.03
$96.95 $117.95
$83.79 $85.69
$98.81 $97.01
$1,500 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
$29.86 $31.09 $40.03 $43.04 $45.68 $48.68
3 - 17
3 - 17
$37.63 $40.51
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$81.03
$96.95 $146.88
$62.18
$75.88 $114.43
$51.85 $103.70 $142.75 $175.19 $55.40 $110.81 $132.80 $161.60 $58.64 $117.28 $115.56 $136.09 $62.76 $125.53 $119.28 $134.93
$80.07 $111.52 $136.80 $86.09 $103.90 $126.40
$91.35 $97.35
$90.16 $106.29 $92.60 $104.81
$3,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$44.08 $45.56
$34.72 $35.10 $45.52 $49.21
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$91.11 $111.66 $168.24
$70.19
$87.17 $130.95
$58.71 $117.44 $164.01 $201.18 $63.11 $126.23 $152.66 $185.71 $67.23 $134.45 $132.73 $156.49 $72.33 $144.66 $137.56 $155.68
$91.03 $128.01 $156.99 $98.43 $119.45 $145.30
$52.57 $105.15 $103.86 $122.50 $56.35 $112.70 $107.22 $121.38
$5,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$49.06 $49.84
$37.43 $38.43
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$99.66 $123.44 $185.54
$76.86
$94.58 $142.37
$64.43 $128.85 $181.09 $222.08 $69.41 $138.83 $168.60 $205.08 $74.13 $148.25 $146.46 $172.78 $79.89 $159.76 $151.98 $172.03
$50.00 $100.00 $139.50 $171.12 $54.19 $108.39 $130.62 $158.93 $58.04 $116.08 $114.43 $134.79 $62.32 $124.65 $118.44 $134.00 * Pricing based off Issue Age
Family rates include up to three children. Additional children are charged the age 3-17 rate per person. Premiums are subject to change. Premium rates based on $1,000, $1,500, $3,000 or $5,000 Policy Year Maximum. Rate based off the age of the eldest/oldest applicant. Benefit exclusions and limitations apply.
VISION RIDER
Age
Individual
Individual + Spouse* Individual + Child(ren)
Family
3 - 17
$2.99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$3.81
$7.61
$9.50
$14.50
$8.16
$16.31
$13.25
$22.48
$8.70
$17.40
$12.89
$22.48
$10.15
$20.30
$11.35
$21.75
$10.15
$20.30
$11.35
$21.75
HEARING RIDER
Age
Individual
Individual + Spouse* Individual + Child(ren)
Family
3 - 17
$1.01
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$0.67
$1.33
$2.59
$3.67
$1.33
$2.67
$3.47
$5.25
$2.50
$5.00
$3.88
$6.67
$3.50
$7.00
$3.91
$7.50
$4.17
$8.33
$3.82
$7.92
* In CA, Spouse or Registered Domestic Partner; In DC, Spouse, Domestic Partner, or Civil Union Partner; In OR, Domestic Partner
Family rates include up to three children. Additional children are charged the age 3-17 rate per person. Premiums are subject to change. Premium rates based on $1,000, $1,500, $3,000, or $5,000 Policy Year Maximum. Rate based off the age of the oldest applicant. Benefit exclusions and limitations apply.
Underwritten by: ManhattanLife Insurance and Annuity Company Administrative Office: 10777 Northwest Freeway, Houston, TX 77092 Toll Free Telephone: 800-669-9030
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)
Scan to learn more about Usual, Customary & Reasonable.
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8Made with FlippingBook - Online Brochure Maker