Renaissance Dental Insurance Plan III

Renaissance Dental is a leader in the dental insurance industry. Renaissance Dental provides access to more than 300,000 dental locations throughout the country. This plan offers the freedom to go to any licensed dentist, however, you may save on out-of-pocket costs by going to an in-network dentist.

Here are some plan benefits.

Preventive care

100% coverage for preventive services when you see an in-network dentist (waiting periods waived)

Basic procedures

Basic services are covered at 80% with in-network dentist (after deductible)

Major procedures

Major services are covered at 50% with in-network dentist (after deductible)

Annual maximum benefit

$1,000 annual maximum

Annual deductible

$50 per person; $150 per family, per calendar year (waived for preventive care)

Waiting periods

None for preventive services; 6 months for basic services

Choose any dentist

Visit any licensed dentist, though you’ll generally save more by visiting a dentist from our PPO network

Now let’s see what this plan includes.

Dental Benefit Highlights for Renaissance Dental Insurance Plan III

Dental Services
Diagnostic & Preventive Services	In-network dentist	Out-of-network dentist	Waiting Periods
Diagnostic and preventive services*—Includes exams and cleanings twice per year, bitewing X-rays, and fluoride treatments to age 14	100%	80%	None
Emergency palliative treatment*	100%	80%
Radiographs/diagnostic imaging*—X-rays	80%	60%

Minor Services	In-network dentist	Out-of-network dentist	Waiting Periods
Periodontal cleaning—Following active periodontal therapy	80%	60%	6 months
Denture and bridge repairs and relines	80%	60%	6 months
Minor restorative services—Silver and white fillings	80%	60%	6 months

Major Services	In-network dentist	Out-of-network dentist	Waiting Periods
Oral surgery services—Extractions and dental surgery, including local anesthesia, suturing, and post-operative care	50%	50%	12 months
Endodontic services—Root canals	50%	50%
Periodontic services—Treatment for diseases of the gums and supporting structures of the teeth	50%	50%
Prosthodontic services—Bridges, dentures and implants	50%	50%
Crown and cast restorations—Metal and porcelain crowns	50%	50%
TMD treatment—Treatment for jaw and facial joint disorders	50%	50%

Maximums and Deductible
Contract year maximum	$1,000 per member
TMD lifetime maximum	$300 per member
Deductible (per contract year) *Deductible waived for these services	$50 per member

Additional Plan Information for Renaissance Dental Insurance Plan III

Maximum Payment for Covered Services:

$1000 per person total per Benefit Year on Class I, Class II and Class III Benefits collectively
$300 per person total per Lifetime for TMD treatment

Deductibles For Covered Services:

$50 per person per benefit year
$150 annual deductible for families.
Deductible does not apply to diagnostic, preventive or emergency palliative treatments.

Waiting Periods

6 months following effective date of insurance: X-rays (not including bitewing), periodontal prophylaxes, denture repair, rebase, relining, minor restorative.
12 months following effective date of insurance: Oral surgery, periodontics, endodontics, crown and cast restorations, prosthodontics and TMD treatment

Additional Plan Information

Benefits for cleanings and oral examinations are payable twice per benefit year.
A third cleanings is payable per benefit year for individuals with a documented history of periodontal disease and a fourth cleanings is payable for two consecutive calendar years following periodontal surgery.
Benefits for bitewing X-rays are payable once per benefit year.
Benefits for full mouth X-rays (which include bitewing X-rays) or a panorex are payable once in any five consecutive years.
Fluoride treatments are payable twice per benefit year for age 13 and under.
Space maintainers are payable once per area in a lifetime for age 13 and under.
Crowns, onlays, dentures, bridges, and substructures are limited to once in a seven-year period.
Benefits for Temporomandibular Disorders (TMD) are limited to those services normally provided by a dentist to relieve oral symptoms associated with malfunctioning of the temporomandibular joint. This does not include services that would normally be provided under medical care.
Composite resin (white) restorations and porcelain crowns are Covered Services on posterior teeth.
Orthodontics and related services are not Covered Services.

The Renaissance PPO network combines leading national and regional PPO networks to offer you maximum choice and value. You can find a participating dentist using the search tool below. If you decide to contact a dental office directly, please refer to the following network partners that a dental office will likely recognize:

Maximum Care
Connection Dental
Maverest Dental Network (formerly Dental Wellness Partners)

Underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN, and in New York by Renaissance Life & Health Insurance Company of New York, Binghamton, NY. Both companies may be reached at PO Box 1596, Indianapolis, IN 46206. Products may not be available in all states and jurisdictions.

The rates displayed are subject to change based upon regulatory approval. For reference, NY1-005, 063, 100-119, NY2-120-149.

Note: Some procedures in the categories may be payable at a different benefit level than indicated. The submission of a pre-determination will provide an estimate of patient out-of-pocket expenses.

The enclosed summaries are samples of benefits. Policies have exclusions and limitations that may limit coverage. For complete coverage details, please refer to your policy, INVD-100A-ID.

Exclusions: Cosmetic surgery or dentistry for aesthetic reasons (except reconstructive surgery for children because of congenital disease or anomaly); general anesthesia and/or intravenous sedation; treatment by anyone other than a licensed dentist or dental hygienist; veneers, sealants, prosthodontics (implants), prefabricated crowns as final restoration on permanent teeth and paste-type root canal fillings on permanent teeth; appliances, procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Policy and/or Summary of Dental Plan Benefits.

Limitations: Coverage for services may be limited based on the age of the person receiving services; coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years); coverage for temporomandibular disorders (TMD) is limited.

The policy has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with the policy provisions. Coverage may be terminated for reasons stated in the policy. Coverage ceases upon termination of the policy. Products and services referred to in this brochure may not be available in all states or jurisdictions.

NOTE FOR NEW YORK RESIDENTS: THESE POLICIES PROVIDE DENTAL INSURANCE ONLY. THE EXPECTED BENEFIT RATIO FOR THESE POLICIES ARE AS FOLLOWS: PLAN III (69.1%). THESE RATIOS ARE THE PORTION OF FUTURE PREMIUMS THAT THE COMPANY EXPECTS TO RETURN AS BENEFITS, WHEN AVERAGED OVER ALL PEOPLE ON THESE POLICIES.

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