Page 55 - Product Summary of Colonial Life_Neat

Dental Plan Comparison

Plan details PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Plan type PPO/MAC PPO/MAC PPO/MAC PPO/MAC PPO

Annual maximum (per person) $1,000 $1,000 $1,500 $2,000 $1,500

Deductible
(Max. three per family; applies per benefit $50 $50 $50 $50 $50
year; does not apply to Class A services)

CO-INSURANCE

Class A (Preventive) 100% 100% 100% 100% 100%
No waiting period

Class B (Basic) 60% 80% 80% 80% 80%
No waiting period

Class C (Major) 40% 50% 50% 50% 50%
12-month waiting period

If offered: Class D (Ortho)
12-month waiting period 50% 50% 50% 50% 50%
Maximum lifetime benefit of $1,000 per child

Based on the
Based on Based on Based on Based on
customary
How out-of-network benefits are paid in-network in-network in-network in-network charge set at the
negotiated rate negotiated rate negotiated rate negotiated rate
90th percentile

Coverage options Plan information:

Employee „ No annual renewal process or rate changes 2

Employee and spouse „ Guaranteed issue, no participation requirement
„ Minimum of three eligible with one enrolled
Employee and dependent children „ Issue age 17-74

Family – employee, spouse and dependent children

Talk with your Colonial Life representative to learn
more about our dental insurance.

1 Internal data, 2017. Access points are sites where network dentists see patients. Some providers may be available at more than one
access point.
2 Rates may only be increased if all rates in the state the policy was issued change.
ColonialLife.com The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations
which may affect any benefits payable. See the actual policy or your Colonial Life benefits representative for specific
provisions and details of availability.
Dental plans are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC,
and administered by Starmount Life Insurance Company.
©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 10-19 | 101855-2