IN-HOUSE INSURANCE

Plan Features:

 • No claim forms

 • No deductibles

 • No waiting periods

 • No yearly maximums

 • Free orthodontic consultations

 • No pre-authorization requirements

 • No pre-existing condition limitation

 

Annual Plan Premiums

Single coverage $649

Dual coverage * $999

Family coverage ** $1299

* Dual coverage is for Husband/Wife, Partner/Partner or Parent/Child.

** Family coverage includes children who are currently enrolled full-time in college until age 26 or children not currently enrolled full-time in college until age 18. This covers 2 dependent children. Additional dependents can be added for an annual premium of $150.

 

Treatment Coverage Table

 

Treatments Plan & Services Coverage

Comprehensive Exam 100%

Periodic Exam (2 per yr) 100%

Limited Oral Exam, Problem Focused (1per yr) 100%

Intraoral - Complete or Panorex (1 per 3 yr) 100%

Intraoral - Periapical, First Film (1per yr) 100%

Intraoral - Periapical, Additional Films (1per yr) 100%

Bitewings (1 set per yr ) 100%

Child Cleaning (2 per yr) 100%

Adult Cleaning (2 per yr) 100%

Fluoride (1 per yr)  100%

 

Sealants 25%

Periodontal (Deep) Cleaning 25%

Fillings 25%

Oral Surgery 25%

Root Canals 20%

Crowns/Bridges 20%

Partials/Dentures 20%

Implants 15%

 

Orthodontics  $400 Off

(full brackets and molar bands, upper and lower arches)

Orthodontic Appliances  25%

 

Whitening 25%

 

Optimum Dental Care Lifetime Care Plan is not a dental insurance plan.

 

This Plan Cannot Be Used:

  • In conjunction with another dental plan
  • On services for injuries covered under workman’s compensation
  • For treatment which, diagnosed by the treating dentist, lies outside the realm of their capability
  • For referrals to specialists
  • For hospitalization or hospital charges of any kind

 

Program Guidelines:

  • Annual plan renewal must take place in initial registration month in order to avoid reinstatement fee
  • There will be a $50 reinstatement fee if your plan lapses
  • Cannot be used in conjunction with another dental plan
  • NON-REFUNDABLE
  • No refunds of premiums will be issued at any time if participant decides not to utilize this dental plan
  • Patient’s treatment investment due at time of service.

 

*Only valid for in office treatment. Does not act as additional coverage for patients who are already covered by insurance.

 

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Phone: 408-942-9999 | Fax: 408-934-9487

Email: dryu@optimumdentalcare.net