Compare the Plans

Value Plan                       $26.89

Deductible (Per Person) $50 ($100 For Ages 65 and older)

Coinsurance (Year One / Year Two)

Preventive 100%

Diagnosic 80% / 100%

Basic 25% / 80%

Major Discount Only

Calendar-Year Maximum

Per Person $500

Waiting Period None

Primary Plan $41.36

Deductible (Per Person)                      $50 ($100 For Ages 65 and older)

Coinsurance (Year One / Year Two)

Preventive                                        100%

Diagnosic                                          60% / 100%

Basic                                                25% / 75%

Major                                               10% / 40%

Calendar-Year Maximum

Per Person                                        $1000

Waiting Period                                    None          

Superior Plan $53.29

Deductible (Per Person) $50 ($100 For Ages 65 and older)

Coinsurance (Year One / Year Two)

Preventive 100%

Diagnosic 90%

Basic                                                 80%

Major 10% / 50%

Calendar-Year Maximum

Per Person $1,250

Waiting Period Four Months

(For Basic Services Only)   

*Rates are for residents of Hawaii only. Rates reflect the monthly premium for single indemnity coverage as of February 2010, and do not include the $1 monthly association dues or the administrative fee of $7.50 for monthly billing, $10 for quarterly billing or $15 for annual billing. Please contact your sales representative to determine rates that include a spouse or dependent children. Claim reimbursement is subject to usual, reasonable and customary charges

 Preventive Care  

• Routine oral exams-limited to two per calendar year 
• Phophylaxis (the cleaning and scaling of teeth) - limited to two per calendar year 
• Topical application of fluoride for dependent children under age 19 - limited to one per calendar year 

Diagnostic Care

• Intra-oral occlusal film
• Bitewing X-rays (up to a set of four) - limited to one per calendar year
• Full-mouth (panoramic film or full series) - frequency no less than 36 months apart   

 Basic Care

• Simple extraction 
• Pin retention (per tooth) - in additon to restorations
• Fillings (restorations) Amalgam restorations - Composite restorations - Sedative fillings
• Anibiotic injections administered by a dentist
• Maintenance prosthodontics - Denture repairs/adjustments - Deture rebase - frequency no less than 24 months apart - Denture reline - frequency no less than 24 months apart

Major Care

• Endodontic treatment 
• Periodontic services 
• Implants 
• Inlays, onlays and crowns 
• Prosthetic services - dentures or bridges 
• Oral surgery 

Dental Plan Underwritten by:

Madison National Life Insurance Company
Madison, WI
Rated A- (Excellent) for financial condition by A.M. Best Company
Standard Security Life Insurance Company
New York, NY
Rated A- (Excellent) for financial condition by A.M. Best Company

*Note that this Dental Plus Hawaii plan information is illustrative only and is not for sales solicitation or distribution. The information is a very brief description of some of the important features of the coverage. Plan benefits and rates are representative of the final product and are not a guarantee of final coverage details or prices. Exclusions and limitations will apply and can be found in the Group Policy #MNL ADEN-POL 0905.