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Dental Maximum Per Person at any Dentist You Choose
*$1,000 per benefit period
*Of this maximum benefit, no more than $500 per benefit period will be paid on major procedures
*Benefits may be subject to usual and customary
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80% COVERAGE FOR PREVENTIVE DENTAL SERVICES after Deductible
*One evaluation per benefit period
*Two cleanings per benefit period
*Fluoride treatment for children under age 14
*One bitewing x-ray once every 12 months
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DENTAL DEDUCTIBLE PER PERSON
*$50 per benefit period
*Applies to Preventive, Basic and Major services
80% COVERAGE FOR BASIC DENTAL SERVICES AFTER DEDUCTIBLE
*Radiograph x-ray once every 5 years
*Sealant for children under age 14. One treatment per permanent molar tooth.
*Limited exams for focused problem
*Restorative amalgams and resin (fillings) (excluding inlays and crowns)
*Oral surgery--simple extractions
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INCREASING BENEFIT FOR DENTAL MAJOR SERVICES AFTER DEDUCTIBLE
*Space maintainer for children
*Anesthesia and oral surgery, complex extraction
*Stainless steel crowns
*Repair of crowns and dentures
*Restorative inlays and crowns
*Root canals, gum disease and prostodontics
--Major service are paid at 10% first year, increases to 25% second year, increases to 50% third year and thereafter. Of the maximum benefit, no more than $500 per benefit period will be paid on major services.
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VISION BENEFIT AT VSP PROVIDERS WITH NO DEDUCTIBLE
*100% coverage for one routine vision exam for each insured once per 12 month period
*20% discount off a complete pair of frames and lenses
*15% discount off contact lens services
*An average discount of 10-25% off laser vision corrective surgery for PRK or LASIK at a VSP provider.
*There are 29,000 providers in the United States
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NFU Monthly Rates for Dental/Vision: Single only--$23.36; Insured & Spouse--$51.68; Insured & Children--$62.04; Family--$90.36
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| Texas Farmers Union, P.O. Box 7276, Waco, Tx 76714-7276 |
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