Dominion dental services inc select plan basic

Exams: No charge for Periodic oral examination twice per calendar year per person
Office visit copay – $10

X-Rays: No charge for bitewing x-rays – 1 to 4 films, twice per calendar year per person
$30 for panoramic film once in three (3) years per person

Fillings: $41 for Amalgam filling-one surface, primary or permanent
$69 for (white filling) Resin based composite-one surface, anterior
$73 for Resin based composite-one surface, posterior

Crowns: $523 for crown-porcelain fused metal
$560 for crown – porcelain/ceramic substrate
See complete fee schedule for different types of crowns covered

Root Canals: $341 for endodontic (root canal) therapy-anterior
$512 for endodontic (root canal) therapy-molar

Braces / Orthodontia: $3,658 for comprehensive orthodontic treatment – adult dentition.
$3,422 for comprehensive orthodontic treatment – adolescent dentition.

Additional Network Information: You may choose any of the conveniently located dental offices from the list of participating dentists. Each family member may select a different participating dentist. Specialty care is covered on this plan. The fees apply only when services are performed by your selected general dentist. Plan Specialist, if available, will reduce fees 25% from Usual, Customary, and Reasonable (UCR) fees, except in the State of Delaware. In Delaware, Plan Specialists will provide a reduction from their UCR that will vary between specialists. Exclusions and Limitations
Privacy Policy
Plan Brochure: N/A

You may change your selected dentist any time by contacting Member Service Department. If notification is received by Dominion National by the 20th of the month the change will be effective on the first of the following month. All outstanding bills with the current dental office MUST be paid before the change will be made effective.

A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions. Work in progress refers to dental treatment that is in the process of being completed. Under certain specific circumstances, work in progress is covered under your plan. Under most circumstances, work in progress is not covered.

You may choose any of the conveniently located dental offices from the list of participating dentists. Each family member may select a different participating dentist.

You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.

An enrollment package will be mailed to you before your first day of eligibility. It will include an ID card, a Description of Benefits & Member Copayments and Certificate of Coverage, which detail your new dental plan.

You and your dependents are eligible. Dependents include your spouse and unmarried children up to age 26. As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.

You may change your selected dentist any time by contacting Member Service Department. If notification is received by Dominion National by the 20th of the month the change will be effective on the first of the following month. All outstanding bills with the current dental office MUST be paid before the change will be made effective.

A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions. Work in progress refers to dental treatment that is in the process of being completed. Under certain specific circumstances, work in progress is covered under your plan. Under most circumstances, work in progress is not covered.

You may choose any of the conveniently located dental offices from the list of participating dentists. Each family member may select a different participating dentist.

You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.

An enrollment package will be mailed to you before your first day of eligibility. It will include an ID card, a Description of Benefits & Member Copayments and Certificate of Coverage, which detail your new dental plan.

You and your dependents are eligible. Dependents include your spouse and unmarried children up to age 26. As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.

Disclaimers & Disclosures This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy. Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses. This site was designed to provide you with a general description of the plans you requested. Keep in mind that it does not include all the benefits and limitations outlined in the policies -- it is the insurance contract, not the general descriptions on this website, which forms the contract between you and the insurance company. DentalInsurance.com is paid by the Insurance Company we represent. We earn commissions for each policy we sell. The commission rates vary by Insurance Company and may increase based on sales volume. There may also be a bonus or incentive. For more information on a purchased plan or plan quoted to you, please reach out through our contact us page. DentalInsurance.com Inc, its suppliers or any third parties named in this site are not liable for any damages that result from using, or inability to use, the website and material listed within it, whether based on warranty, contract, tort or any other legal theory and whether or not DentalInsurance.com Inc is advised of the possibility of such damages. This includes, but is not limited to, incidental and consequential damages, lost profits or damages resulting from lost data or business interruptions. The use of the website and its material, some of it supplied by third parties, is at your own risk. Although we strive to provide the most current and complete information on this website, we make no representations about the accuracy, completeness or timeliness of the material found here. Please note that updates are made periodically to the website and we reserve the right to make them at any time.