Request A Brochure For The Select Dental Plan

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The following documents are available for download (pdf) or, request a brochure by mail or fax.

Select Dental - Brochure

Select Dental - Enrollment Form

Also, see below for a summary of benefits:

Select Dental Summary of Benefits
Calendar Year Deductible
Maximum Calendar Year Benefit
Monthly Premium Rates

Select Dental Summary of Benefits*
Type 1: Diagnostic and Preventive
80%	Diagnostic: Routine periodic examinations once in a 6-month period. Preventive: Dental prophylaxis (teeth cleaning and scaling) once in a 6-month period (including application of topical fluoride for dependent children only).
Type 2: Basic Procedures - 3 month waiting period
80%	Radiography: Bitewing x-rays once in a 6-month period. Full mouth x-rays once in a 36-month period. Palliative: Emergency treatment for relief of pain. Restorative: Amalgam, synthetic porcelain or plastic fillings. Other: Space maintainers, recementation of crowns.
Type 3: Major Procedures - 12 month waiting period
Year 2 and thereafter 50%	*Endodonics: Pupal therapy and root canals. Oral Surgery: Extractions and other oral surgery, including pre- and post-operative care. Periodontics: Treatment of diseases of the gums. Prosthetics*: Gold restorations, crowns, bridges, partial and complete dentures. Other: Pontics, repair of crowns and bridges, full and partial denture repair. 24 month waiting period for replacement of Prosthetic Appliances.

Calendar Year Deductible
Type 1	$10.00 Per Visit $20.00 Maximum Per Benefit Year
Type 2 & 3	$50.00 Per Benefit Year. Limit of 3 Deductibles per family.

Maximum Calendar Year Benefit
$1,000	Combined Type 1,2 & 3 per benefit year, per insured.

Monthly Premium Rates (effective 4/1/07)
Zip Codes	Member Only	Member + 1	Member + 2 or more
905-960	$40.00	$80.00	$120.00
902-904	$42.00	$84.00	$126.00
900-901	$44.00	$88.00	$132.00

* Exclusions and limitations listed in the brochure,
available by fax, snail-mail or download.