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Homeland Dental - $1500 Indemnity Benefit
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$25.00
One-time Fee
$29.50
per Month
for Individual
$59.50
per Month
for Plus 1
$87.50
per Month
for Family
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Dental Plan Indemnity Benefits - See the dentist of your choice, $1500 annual maximum, $50 deductible - waived for preventive services, Set reimbursements for procedures. Cash paid directly to you or your provider.
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Dental Plan
Preferred Scheduled 1500
Indemnity Benefits - See the dentist of your choice.
$1500 annual maximum
Low $50 deductible - waived for preventive services.
Set reimbursements for procedures - no surprises!
Cash paid directly to you or your provider†
Sample Reimbursements
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ADA Code
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Description
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Reimbursement
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0150
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Comprehensive oral evaluation - new or established patient
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$33.00
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0274
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X-Ray - bitewings - four films
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$26.00
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1110
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Routine Prophylaxis - adult (once every six months)
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$38.00
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2331
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Resin filling - two surfaces, anterior
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$50.00
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2750
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Crown -porcelain fused to high noble metal*
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$187.00
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3330
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Root Canal - Molar*
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$196.00
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4341
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Periodontal scaling and root planning - per quadrant*
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$48.00
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7110
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Single tooth (extraction)
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$40.00
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This illustration is a sample only. Please see the member certificate for all codes, exclusions, and limitations.
Click here for a full reimbursement schedule.
† Depending on your provider's billing practice.
†† Documentation consisting of the most recent prior invoice and summary of
benefits must be submitted the time of initial enrollment for waiver to be considered.
* 12 month wait for these services apply.
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Limited Benefit Health Insurance administered by Homeland HealthCare. Limited Benefit Health Insurance underwritten by National Union Fire Company of Pittsburgh, Pa. Limited Benefit Health Insurance is not basic health insurance or major medical coverage and is not designed as a substitute for basic health insurance or major medical coverage. Benefits may vary from state to state. This document provides only brief descriptions of the coverages available. The policies contain reductions, limitations, exclusions, and termination provisions. Full details of the coverage are contained in each policy. If there are any conflicts between this document and each Policy, the Policy, the Policy (series N20000 through N20010) shall govern. Not all coverages are available in every state. Limited Benefit Health Insurance is underwritten by National Fire Insurance Company of Pittsburgh, Pa. with its prinicipal place of business in New York, NY. 10/09
Value Added Benefits are not provided by National Union Fire Insurance Company of Pittsburgh, Pa. National Union Fire Insurance Company of Pittsburgh, Pa. assumes no responsibility or liability for any of the listed services, the providers of the services, the quality of the services, the delivery of the services or the outcomes of the services. Questions or concerns about the Value Added Benefit services should be addressed directly to the providers.
©2009 Homeland4one. All Rights Reserved. Not all programs available in all states. Void where prohibited by law. - Privacy Policy
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