Plan 3000 - Dental Alternatives Insurance Services Inc

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This plan will provide you with excellent dental benefits and save you money. You know how important it is to maintain good oral health and this plan helps with low or no co-payments for preventive services. But there is more than just preventive care … restorative treatment is also covered at co-payments considerably lower than what you might expect to pay without this plan. About this plan … • No waiting periods, claims forms, deductibles or maximums • You will access care through a network of pre-screened general dentists. You and each enrolled dependent may select a different network dentist. • Emergency care is available (see Evidence of Coverage within this booklet). • Specialty care is covered; review the enclosed Schedule of Benefits to find out more.
SmileSaver dental and vision plans are provided by SafeGuard Health <strong>Plan</strong>s, <strong>Inc</strong>. SafeGuard has been a leader in the dental benefits industry for 30 years. Our continued success is due to excellent service, quality products and the fact that, at SafeGuard, our members are our first priority. Member satisfaction is monitored to ensure we meet our goals and your expectations. This booklet contains important information about your benefit plan – including your Schedule of Benefits and Evidence of Coverage. You will receive an ID card after your enrollment has been processed; in the meantime, you may use the temporary card below. Temporary Identification Card PRINT NAME SIGNATURE This card is not required to obtain services
Page 1: Dental HMO SmileSaver 3000 Enrollme
Page 5 and 6: SCHEDULE OF BENEFITS Benefits provi
Page 7 and 8: SCHEDULE OF BENEFITS (continued) Co
Page 13 and 14: DENTAL BENEFITS: EXCLUSIONS The fol
Page 15 and 16: DENTAL BENEFITS: EXCLUSIONS (contin
Page 17 and 18: Benefits Provided by SafeGuard Heal
Page 19 and 20: Section TABLE OF CONTENTS Page At Y
Page 21 and 22: language assistance or would like t
Page 23 and 24: competence and skill of dental prac
Page 25 and 26: SmileSaver Individual & Family Enro
Page 27 and 28: Please refer to the Co-Payment sect
Page 29 and 30: conveyed to You within twenty-four
Page 31 and 32: Renewal Provisions Your Organizatio
Page 33 and 34: may be available to You. If You nee
Page 35 and 36: 1. Your employment ends for any rea
Page 37 and 38: 1. to a person who is not a residen
Page 39 and 40: Covered Service means a dental serv
Page 41 and 42: Prophylaxis means a standard cleani
Page 43 and 44: Health Information only when there
Page 45 and 46: • Right to Inspect and Copy Your
Page 47 and 48: notice from SafeGuard by mail or by
Page 49 and 50: The Schedule of Benefits and the Ex

Plan 3000 - Dental Alternatives Insurance Services Inc

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