DENTAL PLAN COMPARISON CHART
| Class A - Preventive |
Plan I |
Plan II |
Plan III |
Initial & Periodic Exams (2 per year), Cleanings (2 per year),
Fluoride Treatments (to age 16)
|
| |
Benefit Year One |
100% |
80% |
80% |
|
Benefit Year Two |
100% |
80% |
100% |
| |
Benefit Year Three and Each Benefit Year Thereafter |
100% |
80% |
100% |
| Deductible-Lifetime per Insured |
$50 |
$50 |
$50 |
| Waiting Period |
None |
None |
None |
| Class B - Basic |
Plan I |
Plan II |
Plan III |
| X-rays, Filings, Simple Extractions, Sealants (to age 16)
|
|
Benefit Year One |
50% |
50% |
50% |
| |
Benefit Year Two |
60% |
50% |
80% |
| |
Benefit Year Three and Each Benefit Year Thereafter |
80% |
50% |
80% |
| Deductible-Each Calendar Year per Insured* |
$50/Year |
$50/Year |
$75/Year |
| Waiting Period |
None |
None |
None |
| Class C - Major |
Plan I |
Plan II |
Plan III |
| Oral Surgery, Endodontics, Periodontics, Crowns, Bridges, Dentures
|
| |
Benefit Year One |
30% |
25% |
Not Available |
| |
Benefit Year Two |
50% |
50% |
Not Available |
| |
Benefit Year Three and Each Benefit Year Thereafter |
50% |
50% |
Not Available |
| Deductible-Each Calendar Year per Insured* |
$50/Year |
$50/Year |
- |
| Waiting Period |
None |
None |
- |
| Class D - Orthodontics |
Plan I |
Plan II |
Plan III |
| Straightening of Teeth (for children under age 19)
|
| |
Benefit Year One |
0% |
Not Available |
Not Available |
| |
Benefit Year Two |
50% |
Not Available |
Not Available |
| |
Benefit Year Three and Each Benefit Year Thereafter |
50% |
Not Available |
Not Available |
| Deductible |
None |
- |
- |
| Waiting Period |
12 months |
- |
- |
| Calendar Year Maximums |
Plan I |
Plan II |
Plan III |
| Calendar Year Maximum for Classes A, B and C Combined
|
$1,500 |
$1,000 |
$1,000 |
| Calendar Year Maximum for Class C - Major Services
|
$750 |
$500 |
N/A |
| Calendar Year Maximum for Class D
|
$500 |
- |
- |
| Calendar Year Maximum Per Child for Class D
|
$1,000 |
- |
- |
| *Class B & C Deductible is combined for each calendar year. A maximum of three (3) individual deductibles per family shall apply. |
GemStar Voluntary Group Dental Plans reimburse for
covered dental expenses based upon the Reasonable and Customary (R&C) fees
for those covered expenses.
STATE RESTRICTIONS
| State |
Limitation |
| Connecticut |
Not Available |
| New Hampshire |
Not Available |
| New York |
Not Available |
| South Dakota |
Plan I Not Available |
| Washington |
Not Available |
Credit for Prior Time (CPT)
Credit towards
satisfaction of any [benefit year class/waiting period class] may be given
for the length of time an employee was covered under the employer’s prior
dental insurance plan, provided there is no interruption in
coverage between the prior plan and the replacement plan. The insured
applying for CPT must have been covered for the same benefit classes under
the prior plan in order to receive credit under the new plan. In other
words, if the employer’s prior plan did not provide Major or Orthodontic
class coverage and the new plan provides both, CPT may not be given for the
class not previously provided.
CPT is given
individually to each person (employee, spouse or child) covered. Any new
employee and/or dependents added on or subsequent to the group’s effective
date of this coverage, will not receive CPT. The agent has no
authority to grant CPT or to waive the waiting period provision of the Plan.
DENTAL PLAN DESCRIPTIONS (click to view the plan description)
GemStar Dental Plan l Description
GemStar Dental Plan ll Description
GemStar Dental Plan lll Description
GemStar Dental Plan Comparison Chart (compares all three side by side)
GemStar Dental Plan Guidelines and Exclusions
Terminology
Frequently Asked Questions
If you are interested in marketing GemStar Group Dental and Vision Plans (click here).
If you are interested in purchasing GemStar Group Dental and Vision Plans (click here).