Plan 3000 - Dental Alternatives Insurance Services Inc

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000692332/3149-CA-DAIS-CDT9KIT-1
The Schedule of Benefits and the Exclusions and Limitations contained within this enrollment kit are provided to give you the details of your benefit plan. Also included is your Evidence of Coverage, which provides further information regarding plan benefits. Benefits provided by SafeGuard Health Plans, Inc. SafeGuard®is a registered trademark of SafeGuard Health Enterprises, Inc. SmileSaversm is a registered servicemark of SafeGuard Health Enterprises, Inc.
Page 1 and 2: Dental HMO SmileSaver 3000 Enrollme
Page 3 and 4: SmileSaver dental and vision plans
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: notice from SafeGuard by mail or by

Plan 3000 - Dental Alternatives Insurance Services Inc

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