transsmile
Type I – Diagnostic & Preventative** 100% •
Type II – Basic Restorative Services*** 80% •
Type III – Major Restorative Services**** 50% •
* Out of network reimbursement based on maximum allowable (MA). ** Type I services include: exams, cleanings, topical fluoride, space maintainers and bitewings *** Type II services include: x-rays, emergency treatment for pain, fillings, and simple extractions. **** Type III services include: denture repair, oral surgery (except TMJ), non-surgical periodontics, surgical periodontics, periodontal maintenance, crowns, inlays, onlays, veneers endodontics, prosthodontics and implants. (12 month waiting period for Type III); other limitations and exclusions may apply. See policy for details.
Additional Benefit Information
Waiting Period
Type III Services – 12 month waiting period
Dependent Eligibility
Eligible dependents of the insured include the insured’s lawful spouse and unmarried children less than 19 or less than 23 if a full-time student.
Annual Maximum
Applies individually to member and each covered family member per policy year. $500
- Basic $1,000
- Preferred
Annual Deductible
Applies to Type II and III
- Basic $50
- Preferred $50
| member only | $18.89 | $25.30 |
|---|---|---|
| member+spouse | $30.97 | $43.79 |
| member+child(ren) | $37.12 | $45.77 |
| family | $52.58 | $68.06 |
TransSmile Group Dental Insurance is underwritten by Transamerica Life Insurance Company. Home Office: Cedar Rapids, IA, Policy Form Series CPDEN100, CCDEN100.