Optional Vision Insurance Plan
The optional vision plan is available through the EyeMed Vision Care Network. EyeMed is a leading vision benefits company, offering the following features:
• Savings on eye care, frames, lenses and other options
• Quality standards for care and materials
• Access to thousands of providers nationwide, including the nation’s top optical retail brands
Spirit Dental Insurance - Deductibles
* Deductibles are to a maximum of 3 Individual Deductibles per family.
* $50 Preventive Lifetime deductible per person.
* $50 combined Basic/Major calendar year deductible per person to a maximum of 3 individual Deductibles
per family per calendar year.
ELIGIBLE EXPENSES: Expenses must be incurred while the Policy is in force and
the person is covered by the Policy. To become an Eligible Expense, the dental services
must be performed by: a licensed Physician performing dental services within
the scope of his license; or a licensed dental hygienist acting under the supervision
and direction of a Dentist.
EXPENSES INCURRED: An Eligible Expense is considered incurred on the following
dates: for full and partial dentures - on the date the final impression is taken; for fixed
bridges, crowns, inlays and onlays - on the date the teeth are first prepared; for root
canal therapy - on the date the pulp chamber is opened; for peridontal surgery - on the
date surgery is performed; for all other services - on the date the service is performed.
DENTAL EXPENSES NOT COVERED: No benefits will be paid for expenses incurred:
for overdentures and associated procedures; for charges in excess of those considered
reasonable and customary; for cosmetic procedures; for the replacement of dentures,
bridges, inlays, onlays or crowns that can be repaired or restored to normal function;
for replacement of lost or stolen appliances, replacement of retainers, athletic mouthguards,
precision or semi-precision attachments, denture duplication; for oral hygiene
instructions and for plaque control, completion of a claim form, acid etch, broken appointments,
prescription or take-home fluoride, or diagnostic photographs; for services
not completed by the end of the month in which coverage ends unless continuation of
coverage has been requested and accepted by Us; for procedures that are begun, but
not completed; for services and treatment provided without charge or for which there
would be no charge in the absence of insurance; for services in connection with war or
any act of war, whether declared or undeclared, or condition contracted or accident occurring
while on full-time active duty in the armed forces of any country or combination of
countries; for a condition covered under any Worker's Compensation Act or similar law;
that are applied toward satisfaction of a Deductible, if any; that are generally considered
by the dental profession as experimental or investigational; for the treatment of cleft palate
and anodontia; for services or supplies payable under any medical expense plan;
for orthodontia, unless included within Coverage Schedule; prior to the date the Insured
is covered under the Policy; for the diagnosis or treatment of Temporomandibular Joint
Dysfunction (TMJD); for hospital services; if You voluntarily end your insurance You
will not be eligible to re-enroll for a period of 2 years after the date Your coverage first
ended; charges for infection control, sterilization and waste disposal.
ALTERNATE BENEFIT: If: (1) We determine that a less expensive alternate procedure,
service or course of treatment can be performed in place of the proposed treatment
to correct a dental condition; and (2) the alternative treatment will produce a
professionally satisfactory result, then the maximum we will allow will be the charge for
the less expensive treatment.
MISSING TOOTH: When covered under your plan, benefits are provided for placement
of dentures, fixed bridgework, implants or the addition of teeth to existing dentures
only when the service includes replacement of a natural tooth extracted or lost
while covered under this plan. This limitation ends after the individual receiving care
has been covered under this plan for 36 consecutive months.