Summary of Coverage Temporary Health Insurance

Quick Facts The Competitor Smile Dental Plan
Choose Maximum Benefit Options of $1000 or $1500 Per Insured, Per Year Benefit Schedule Per Insured Person
Care	Deductible	Benefit	Beginning
Preventative Exams, Cleaning	$35 Lifetime	80%	Day One
Basic* Fillings, Extractions, X-Rays, Oral Surgery	$50 Per Year	50%	6 Months
Major* Crowns, Bridges, Root Canals, Dentures, Perio Surgery	$50 Per Year	50%	15 Months
Orthodontia** Straightening of Teeth	No Deductible	50%	24 Months
Combined Basic and Major deductible. *Orthodontia child coverage is Included. The maximum benefit per insured child per year is $500 up to a lifetime maximum of $1000 per insured child.

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ELIGIBILITY AND EFFECTIVE DATE:
You and your spouse age 18 through 64 and your unmarried dependent children under age 19 (or 23 if a full time student) may apply for coverage.

The earliest coverage can begin will be either the 1st or the 15th of the month, but not before HPA receives the application. If the application is received between the 1st and 14th, coverage will begin on the 15th of that month. If application is submitted between the 15th and before the 1st of the next month, coverage will begin on the 1st of the next month.

HOW THIS PLAN WORKS:
This plan reimburses you for covered dental expenses based upon a percentage of the Reasonable and Customary* (R&C) fees for those Covered Expenses.

After a One-Time $35 Deductible, this plan will reimburse you no more than 80% of the *R&C rate for Preventive Dental Services.
After a $50 Annual Deductible, this Plan will reimburse you no more than 50% of the *R&C rate for Basic and Major Orthodontic Dental Services.
This Plan lets you select your own dentist.

This plan is affordable for you and your family!

*Reasonable and Customary fees are charges that do not exceed the general level of charges being made by other providers of dental services in the state where the charge is incurred.