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Summary
of Benefits:

Individual Plans

dentalCOMPANION
PPO / Indemnity Plan (1)

In-Network / Out-of-Network(4)

In-Network

 Out-of-Network
Preventive
Office visit, cleaning, oral exam and x-rays

Examples:
D120 (Periodic Oral Exam) Plan Allows $25
D1110 (Prophylaxis - Adult) Plan Allows $56
No Deductible or Waiting Period on Preventative Services

100%
after $10 co-pay		 None
Basic
Simple extractions and fillings
Examples:
D2140 (Amalgam - One Surface Prim/Perm) Plan Allows at least $56
D3330 (Molar Root Canal) Plan Allows at least $310
No Deductible or Waiting Period on Basic Services
80%
average savings		 None
Major
Crowns, bridges, dentures, inlays, periodontics, endodontics and oral surgery
Examples:
D2752 (Crown - Porcelain Fused to Noble Metal) Plan Allows at least $309
D5120 (Complete Denture - Mandibular) Plan Allows at least $362
50% average savings
 None
Orthodontics
25% discount
at participating TDA Provider
 / No Out of Nework Benefit

25% average discount
at participating provider

 None
Waiting Periods
 12 months on major services None
Deductible
 $25 per subscriber per calendar year
for basic and major services		 None
Annual Maximum
 $1,000 per subscriber None
Additional Information

Click here to obtatin a complete listing of benefits
Click to search participating providers (Utilizes TDA - PPO Network)

Enrolling in the dentalCOMPANION plan provides access to Value Added benefits such as Hearing, Vision, and Perscription Discounts!

Click here to obtatin a complete listing of benefits
Click to search participating providers

25% discount on specialist services: Periodontist, Endodontist, Prosthodontist, Pediatrics and Oral Surgeon at In-Network providers.
TDA - DHMO - Prepaid Network
Payment Method
   Monthly
Annual
   Monthly
Annual

All Plans allow Monthly payments by Visa, MasterCard, Discover, American Express or automatic bank account withdrawals.

 Monthly Rate Under 65  
Individual $29.34 $352.08 Individual $17.00 $204.00
Individual + 1 $56.47 $677.64 Individual + 1 $29.00  $348.00 
Individual + 2 $92.56 $1110.72  Individual + 2 or more $45.00 $540.00
Monthly Rate Over 65    
Individual $35.21 $422.52
Individual + 1 $67.04 $804.48
Individual + 2 $103.77 $1245.24

(1) dentalCOMPANION Plan is underwritten by Companion Life Insurance Company. (2) TDA - A800 Plan insured and underwritten by Total Dental Administrators. For complete fee schedule please refer to the plan certificate. (3) Dental Eclipse II Plan is not insurance; it is a reduced fee plan comprised of participating dental providers who have agreed to accept a discounted fee for their services. (4) All payments made by the plan are based on the network fee schedule. For complete details of the coverage please refer to the plan certificate. Plans may vary by state.

** Plan reimbursement is fixed.
 
   


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