Traditional Plans are available voluntary or employer paid.
| Benchmark Plan | Open Choice Plan | Incentive Plan | Opportunity Plan | ||
|---|---|---|---|---|---|
| Plan Type | Indemnity | Passive PPO | Incentive PPO | Passive PPO | |
| Reimbursement Method In/Out | UCR | DPO/UCR | DPO | UCR | DPO/DPO |
| Diagnostic & Preventive | 100% | 100% | 100% | 80% | 100% |
| Minor Restorative | 80% | 80% | 80% | 60% | 80% |
| Oral Surgery | 80% | 80% | 80% | 60% | 80% |
| Endodontics | 50% | 50% | 50% | 40% | 50% |
| Periodontics | 50% | 50% | 50% | 40% | 50% |
| Major Services | 50% | 50% | 50% | 40% | 50% |
| Ortho (Child Only) | 50% | 50% | 50% | 40% | 50% |
| Deductible | $50/150 | $50/150 | $50/150 | $50/150 | |
| Ded waived for D&P | Yes | Yes | Yes | Yes | Yes |
| Annual Maximum | $1,000 | $1,000 | $1,000 | $1,000 | $1,000 |
| Ortho Lifetime Maximum | $1,000 | $1,000 | $1,000 | $1,000 | $1,000 |
| Waiting Periods: | New Groups: Vary by group size and plan design selected Takeover Groups: No waiting periods for enrollees and their dependents who were enrolled in employer’s prior plan. |
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DPO reimbursement is based on the negotiated provider fee schedule; UCR reimbursement is based on Usual, Customary, & Reasonable (UCR) charge.
Plan Type: Passive PPO
Reimbursement Method In/Out: DPO / UCR
| 1st Benefit Year | 2nd Benefit Year | Thereafter | |
|---|---|---|---|
| Diagnostic & Preventive | 100% | 100% | 100% |
| Minor Restorative | 80% | 80% | 80% |
| Oral Surgery | 80% | 80% | 80% |
| Endodontics | 10% | 25% | 50% |
| Periodontics | 10% | 25% | 50% |
| Major Services | 10% | 25% | 50% |
| Ortho (Child Only) | 10% | 25% | 50% |
| Deductible | $50/150 | $50/150 | $50/150 |
| Ded waived for D&P | Yes | Yes | Yes |
| Annual Maximum | $1,000 | $1,000 | $1,000 |
| Ortho Lifetime Maximum | $1,000 | $1,000 | $1,000 |
DPO reimbursement is based on the negotiated provider fee schedule; UCR reimbursement is based on Usual, Customary, & Reasonable (UCR) charge.
A two-layer approach to Dental
| A | B | C | |
|---|---|---|---|
| Reimbursement Method In/Out | DPO / UCR | DPO / UCR | DPO / UCR |
| Diagnostic & Preventive | 100% | 100% | 100% |
| Minor Restorative | Discount Card | 80% | 80% |
| Oral Surgery | Discount Card | 80% | 80% |
| Endodontics | Discount Card | Discount Card | 80% |
| Periodontics | Discount Card | Discount Card | 80% |
| Major Serivces | Discount Card | Discount Card | Discount Card |
| Orthodontics | Discount Card | Discount Card | Discount Card |
| Deductible | $50/150 | $50/150 | $50/150 |
| Ded waived for D&P | Yes | Yes | Yes |
| Annual Maximum | $1,000 | $1,000 | $1,000 |
DPO reimbursement is based on the negotiated provider fee schedule; UCR reimbursement is based on Usual, Customary, & Reasonable (UCR) charge.
This Plan couples MWG Dental Insurance with a Discount Card to provide dental coverage for all services.
This discount card is not insurance. The card provides discounts from network providers for all services not included under the insurance policy. (Including root canals, crowns, bridges, child and adult ortho, cosmetic treatments, bonding and veneers). No waiting and discounts ranging from 20% to 50%.
Consumer MaxMultiplier is a consumer-driven feature included with all of MWG Dental plan designs that puts dental care decisions directly in the hands of the consumer. You have the ability to increase your annual maximum each year at no additional cost.
If no claims are submitted during the benefit period, no awards are earned and there is no penalty or loss of any previously accumulated award balance. Should your group enroll in an MWG Dental plan or if you are a new hire in the last three months of the benefit year your participation in the Consumer MaxMultiplier will be deferred until the first month of the next full benefit period.
See Example. Different original annual maximums have different accumulations.
| Consumer MaxMultiplier Design – Specific Plan Options | |||||
|---|---|---|---|---|---|
| Original Annual Max | Annual Claim Threshold | Annual Account Award | Annual Network Bonus | Annual Award + Bonus Max | Increased Annual Maximum |
| $1,000 | $500 | $250 | $100 | $350 | 2nd year – $1350 |
| $1,000 | $500 | $250 | $100 | $350 | 3rd year – $1700 |
If you keep your claims below $500 per year, you will carry over $250 dollars toward your next year’s annual maximum. Earn an additional $100 carryover by making all your dental visits to one of our PPO providers. Maximum reward accumulation is $1,000. Awards have no cash value.
Coverage is subject to certain conditions, limitations and exclusions, which are detailed in the group policy as well as the certificate. If there is a conflict between what is described in this brochure and your group policy, the group policy will prevail. For a complete listing of the plan provisions, as well as any limitations and exclusions, please refer to the group policy
Any provision of the group policy which, on its effective date, does not agree with the laws of the state in which the policy is written, will be amended to the minimum requirements of those laws.