The PPO plans, underwritten by Assurant Employee Benefits, are called the Freedom Preferred plans. There is a High and a Low Option. These plans provide a variety of benefits, under which you and your family have the freedom to use any dentist or specialist anywhere. If you choose to use an in network dentist, you will pay your deductible when applicable and the coinsurance that corresponds to your procedure. If you choose a non network provider, then you will be balanced billed by that dentist. With both plans you have $1,000 in benefits for each covered member available to use each plan year (Nov. 1 – Oct. 31). Once Assurant has paid out this maximum, you will be responsible for 100% of the costs thereafter. The High Option offers child orthodontia coverage for children under the age of 19 that are not currently undergoing treatment. The orthodontia benefit pays 50% of the first $2,000 of treatment. Costs above this are the covered member’s responsibility. Claim payments for non network providers may be made to you or your dentist, whichever you prefer, unless benefits have been assigned to the provider. If you use a non participating provider your cost will be higher because Assurant has negotiated discounts on your behalf with their participating providers. If you are having services in excess of $300 your provider must submit their treatment plan to Assurant for benefit determination. Freedom PPO Plan Features: • Freedom to chose any dentist, including specialist • Nationwide coverage • Fast and accurate claims service • No referrals required • Treatment plan benefit determination for services over $300 Visit Assurant’s website at www.assurantemployeebenefits.com for more information on participating dentists in your area or contact customer service at 1-800-442-7742. Freedom PPO Dental Plans: Freedom Preferred Freedom Preferred Plan Summary Low Option High Option In Network Benefits: Deductible $50 per person $50 per person Waived for Preventive Yes Yes Coinsurance (Plan Pays) Preventive Services 100% 100% Basic Services 90% 90% Major Services 30% 60% Orthodontic Services Not Covered 50% Plan Year Maximum $1,000 $1,000 Lifetime Orthodontia Maximum Not Covered $1,000 Out of Network Benefits: Deductible $50 per person $50 per person Waived for Preventive Yes Yes Coinsurance (Plan Pays) Preventive Services 100% 100% Basic Services 80% 80% Major Services 10% 50% Orthodontic Services Not Covered 50% Plan Year Maximum $1,000 $1,000 Lifetime Orthodontia Maximum Not Covered $1,000 Additional Plan Specifications: Major Endodontics & Periodontics Major 90th Usual & Customary Percentile 90th Maximum Allowable 20% off the 80th Percentile 20% off the 80th Percentile Limitations and Exclusions No benefits are payable for: natural teeth missing on date of insurance; care that is not necessary or not listed under the Schedule of Dental services in your group Policy; not professionally endorsed; experimental or cosmetic in nature; care for which there is no legal obligation to pay; not incurred while insured; work related; TMJ disorders; orthodontics (on the Freedom Low plan); implants; vertical dimension; bite registration; emergency oral exam; loss due to war, riot, felony, or assault. Benefit Adjustments Benefits will be coordinated with any other dental coverage. Under the Alternative Treatment provision, benefits will be payable for the most economical services or supplies meeting broadly accepted standards of dental care. If the cost of a proposed Dental Treatment Plan exceeds $300, it should be submitted to Assurant Employee Benefits for an estimate of benefits payable. Eligibility Full-time employees, spouses, and unmarried, dependent children (up to age 25). This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy for a complete list of covered dental services and the Maximum Covered Expense. The Group policy alone determines all rights, benefits, and applicable Limitations and Exclusions.
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