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Renaissance Dental is a leader in the dental insurance industry. Renaissance Dental provides access to more than 300,000 dental locations throughout the country. This plan offers the freedom to go to any licensed dentist, however, you may save on out-of-pocket costs by going to an in-network dentist.
Individual annual deductible
(waived for preventive services)
|$50 per person||$50 per person|
Family annual deductible
|$150 per family||$150 per family|
|Annual Benefit Maximum||$1,000 per person||$1,000 per person|
|Diagnostic & Preventive Services||In-network dentist||Out-of-network dentist||Waiting Periods|
|Diagnostic and preventive services*—Includes exams and cleanings twice per year, bitewing X-rays, and fluoride treatments to age 14||100%||80%||None|
|Emergency palliative treatment*||100%||80%|
|Minor Services||In-network dentist||Out-of-network dentist||Waiting Periods|
|Periodontal cleaning—Following active periodontal therapy||80%||60%||6 months|
|Denture and bridge repairs and relines||80%||60%||6 months|
|Minor restorative services—Silver and white fillings||80%||60%||6 months|
|Major Services||In-network dentist||Out-of-network dentist||Waiting Periods|
|Oral surgery services—Extractions and dental surgery, including local anesthesia, suturing, and post-operative care||50%||50%||12 months|
|Endodontic services—Root canals||50%||50%|
|Periodontic services—Treatment for diseases of the gums and supporting structures of the teeth||50%||50%|
|Prosthodontic services—Bridges, dentures and implants||50%||50%|
|Crown and cast restorations—Metal and porcelain crowns||50%||50%|
|TMD treatment—Treatment for jaw and facial joint disorders||50%||50%|
|Maximums and Deductible|
|Contract year maximum||$1,000 per member|
|TMD lifetime maximum||$300 per member|
|Deductible (per contract year) *Deductible waived for these services||$50 per member|
Plans underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN, and in New York by Renaissance Life & Health Insurance Company of Binghamton, NY.
The rates displayed are subject to change based upon regulatory approval. For reference, NY1-063, 100-119, NY2-120-149.
Note: Some procedures in the categories may be payable at a different benefit level than indicated. The submission of a pre-determination will provide an estimate of patient out-of-pocket expenses.
The enclosed summaries are samples of benefits. Policies have exclusions and limitations that may limit coverage. For complete coverage details, please refer to your policy, INVD-100A-ID.
Exclusions: Cosmetic surgery or dentistry for aesthetic reasons (except reconstructive surgery for children because of congenital disease or anomaly); general anesthesia and/or intravenous sedation; treatment by anyone other than a licensed dentist or dental hygienist; veneers, sealants, prosthodontics (implants), prefabricated crowns as final restoration on permanent teeth and paste-type root canal fillings on permanent teeth; appliances, procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Policy and/or Summary of Dental Plan Benefits.
Limitations: Coverage for services may be limited based on the age of the person receiving services; coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years); coverage for temporomandibular disorders (TMD) is limited.
The policy has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with the policy provisions. Coverage may be terminated for reasons stated in the policy. Coverage ceases upon termination of the policy. Products and services referred to in this brochure may not be available in all states or jurisdictions.
Underwritten by Renaissance Life & Health Insurance Company of America, PO Box 1596, Indianapolis, IN 46206