mycornmarket dental-teamcare-1-benefits

TeamCare Level 1 Plan - Benefits

Applicable to new registrations or renewals on or after 1st November, 2015. This Schedule of Benefits must be read in conjunction with the DeCare Dental Terms and Conditions Booklet

Section 1 - Investigative and Preventive Treatment – No Waiting Period Benefit Limit 

Examinations

·         Two times per calendar year 100%

Scaling and polishing

·         Two times per calendar year 100%

Radiographs (x-rays): 

Bitewings coverage:

·         1 series per 12 month period for insured persons up to the age of 18 years 100%

·         1 series per 24 month period for insured persons over 18 years 100%

Full Mouth (Complete Series) or Panoramic

·         Covered once per 60-month period 100%

Periapical(s)

·         4 single x-rays are covered per 12-month period 100%

Occlusal

·         2 series per 24-month period 100%

Section 2 - Emergency Treatment – No Waiting Period Benefit Limit

·         Once per 12 month period for the immediate, temporary relief of pain or infection 100%

Section 3 - Basic treatment – 3 month waiting period applies Benefit Limit

Restorations (fillings)

·         Once per tooth surface per 24 month period 40%

Pre-fabricated or Stainless Steel Crowns

·         Once per tooth per 60-month period for eligible dependant children up to the age of 19 40%

Sealants

·         Once per tooth per lifetime for permanent first and second molars of eligible dependant children up to the age of 16 40%

Space Maintainers

·         Once per tooth per lifetime on eligible dependant children up to the age of 17 for extracted primary posterior (back) teeth 40%

Periodontal Treatment

·         Periodontal scaling and root planing - once per quadrant per 36 month period 40%

·         Full mouth debridement - once per tooth per lifetime 40%

·         Periodontal maintenance - once per 24 month period 40%

Tooth extractions

·         Tooth extraction - once per tooth per lifetime 40%

Section 4 - Major treatment – 12 month waiting period applies Benefit Limit

Endodontic Therapy on Primary Teeth

·         Pulpal therapy - once per tooth per lifetime 40%

·         Therapeutic pulpotomy - once per tooth per lifetime 40%

Endodontic Therapy on Permanent Teeth

·         Root canal therapy - once per tooth per lifetime 40%

Prosthetic Services - Dentures

·         Removable prosthetic services (Dentures) - once per 5 year period 40%

·         Reline and rebase - 1 per 24 month period 40%

·         Repairs, replacement of broken artificial teeth, replacement of broken clasp(s) - 1 per 6 month period 40%

·         Denture adjustments - 2 times per 12 month period 40%

Prosthetic Services - Bridge and Implant Supported Crowns

·         Fixed prosthetic services (Bridge) - once per 5 year period 40%

·         Bridge adjustments - 2 times per 12 month period 40%

·         Implant supported crowns - once per tooth per 5-year period 40%

Crowns, Inlays and Onlays

·         Permanent crowns, inlays and onlays - once per tooth per 5-year period 40%

·         Crown repair - once per tooth per 12 month period 40%

Please Note:

A separate annual maximum of €500 per period of insurance applies to crowns, inlays and onlays. €500

Section 5 – Annual Policy Maximum

This applies to all sections of your plan (excluding crowns, inlays and onlays which has a separate maximum of €500). Maximum benefits may not be carried over to future years of cover.

·         Annual policy maximum per member per year €1,400