Benefits
With comprehensive dental coverage, you have 100 percent coverage on routine exams, cleanings and other preventive services, as well as 50 percent coverage on restorative care, prosthetics and other dental services.
How to enroll
If you're enrolling in the Freedom plan for the first time, select dental coverage when you enroll. You can enroll for medical, prescription drug and dental coverage using the same form.
If you are a current Freedom plan member, you can add dental coverage during the Annual Enrollment Period from October 15 through December 7, 2011. To enroll, please fill out this form and then mail or fax it to Medicare Sales.
Benefit |
Coverage |
|---|---|
| Monthly Premium | $38.37 |
|
Preventive and Dianostic Care
|
100% Coverage |
|
Sealants
|
50% Coverage |
|
Regular and Resorative Care
|
50% Coverage |
|
Special Restorative Care
|
50% Coverage |
|
Prosthetics
|
50% Coverage |
| Annual Deductible | $50 per calendar year for regular and restorative care, special restorative care and prosthetics. |
| Annual Maximum |
$1,100 per calendar year. $200 may be applied to out-of-network services. Preventive and diagnostic services do not apply to the annual maximum for Freedom Balance and Freedom Ultimate. Preventive and diagnostic services do apply to the annual maximum for Freedom Vital. |
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premiums and/or copayments may change on January 1, 2013.