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Prepaid Dental for Maricopa Community College

Prepaid Dental for Maricopa Community College. Assurant Employee Benefits Prepaid Plans Heritage Plus Plan. with Specialty Benefit Amendment. Plan limitations and exclusions apply. Prepaid Plan Features:. No Deductibles No Claim Forms to File No Annual Dollar Maximums

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Prepaid Dental for Maricopa Community College

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  1. Prepaid Dental forMaricopa Community College

  2. Assurant Employee Benefits Prepaid PlansHeritage Plus Plan with Specialty Benefit Amendment Plan limitations and exclusions apply.

  3. Prepaid Plan Features: • No Deductibles • No Claim Forms to File • No Annual Dollar Maximums • No Waiting Periods for Services • Coverage for Pre-existing Conditions • Emergency Coverage • Cosmetic Dentistry

  4. Schedule of Copayments forAssigned Family Dentistfor Arizona Heritage Plus plan ADA Code Procedure Member Co-payment 999 Routine Office Visit $10.00 1110 Prophylaxis - Adult $5.00 Cleaning (Semi-Annually) 2750 Crown - PFM $265.00 (Lab Fee Additional)

  5. Schedule of Copayments forSpecialist accepting SBA in-networkfor Arizona Heritage plan ADA Code Procedure Member Co-payment 150 Comprehensive Oral Eval. $45.00 3330 Root Canal (Molar) $395.00 4341 Perio. Scaling and Planing $100.00 7240 Removal impacted tooth $200.00

  6. Prepaid PlanSpecialty Benefit Amendment • Member Copayment to Specialist • 15% Endodontics discount and 25% discount on all other specialists if procedure NOT listed on Specialty Benefit Amendment • 25% discount on Orthodontic Services • (Adult and Child) • No Referral Required • No Annual Dollar Maximums

  7. Specialist directory“S” indicates the specialist accepts the SBA

  8. Prepaid PlanDirectory of Dentists • Ability to change dentists • Each family member may select a different dentist www.assurantemployeebenefits.com

  9. Assurant Employee BenefitsPrepaid ArizonaParticipating General Dentist Directory As of Feb 9, 2005

  10. Prepaid Customer Service Number 1-800-443-2995 Business hours to assist you: 7:00am-5:30pm Central time, Monday-Friday Automated Eligibility System Business hours to assist you: 7:00am-7:00pm 7 days per week www.assurantemployeebenefits.com (Heritage Plans Network)

  11. Vision Services Plan(included with all dental plans) • Discounts on exams, eyeglasses, laser vision care, contact lenses, sunglasses • No waiting periods • No deductibles • No claim forms to fill out VSP Customer Service 1-800-877-7195 www.vsp.com

  12. Assurant Employee Benefits will mail to member’s home: • ID Cards (Dental & Vision)• Evidence of Coverage• Copayment Schedule

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