SMILE. WE'VE GOT YOU COVERED.

MEMBER DENTAL AND VISION BENEFITS.

CHOICE PPO PREMIUM

 

 

The Choice PPO Premium plan offers maximum access to dentists and greater coverage.
Members may seek dental services from any licensed dentist or use a participating Choice PPO network dentist for greater coverage.
When dental care is received and expenses incurred, payments will be made in accordance with the list of benefits and services in the Coverage Schedule that will be sent to you with your membership card.
 
no charge for oral exams, cleanings, bitewing x-rays and other preventive services.
 

More extensive care (fillings, dentures, crowns, root canals, periodontal care, oral surgery, etc.) is covered. Please see the Plan Comparison chart for more information.

There are no waiting periods for Class I or Class II services. There is a 6-month waiting period for Class III services.

Out-of-network dentists may charge above the amount covered by the Dominion plan, which will be balanced billed to you, the member. To ensure you do not receive additional out-of-pocket charges, visit a participating dentist in the Choice PPO network.

CHOICE PPO PREMIUM benefits include

 
NO CHARGE for routine semiannual cleanings, oral exams and other preventive care
 
 
NO WAITING PERIODS for Class I and Class II services
    ADDITIONAL CLEANING covered for diabetics and expecting mothers
 
 
    $50 DEDUCTIBLE per member
 
 
    $1,500 ANNUAL MAXIMUM per person

 

"NO-CHARGE" PROCEDURES
account for over 65% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.1

 

ACCESS TO OVER
300,000

DENTISTS2
 
 
1 Dominion National - based on annual review of utilization data.
2 Dominion National Internal Performance Report, November 2017. Participating providers are subject to change.