Benefits

Underwritten by Fairmont Premier Insurance Company

Now you and every dependent member of your family each have:

• $1000 of Insured Dental Benefits per calendar year paid per Dental Schedule of Eligible Expenses ($50 Deductible). See list of Schedule of Dental Eligible Expenses.
• Deductible is waived on two (2) cleanings per person per year.
• Your IAB Dental Care Plan can be used at any dentist and provides a scheduled reimbursement.
• Procedures Include: Porcelain Crown, Composite Filling, Simple Extraction, Regular Teeth Cleaning, Periodontics, Complete Dentures, Root Canal, X-Rays, Endodontics, Sedative Filling, Amalgam Filling, Periodic Oral Exam, Initial Oral Exam, Deep Teeth Cleaning and much more... (Note: waiting periods may apply).
• Eligibility and Effective Dates: This insured benefit is effective on the first day of the month following the date your completed application for membership is received and processed. Coverage for legal Dependants you acquire after your coverage is effective will be effective on the first day of the month following the date you acquire the dependent except that coverage for newborn children is effective on the date of birth and coverage for adopted children is effective on the date you become a party in suit to the adoption. For purposes of this benefit: a legal dependent over 19 is required to be a full time student; and a legal dependent includes your grandchild, a child for whom you must provide medical support, a child for whom you are a party in suit for adoption and a child age 25 who is primarily dependent upon you for support because he or she is incapable of self sustaining employment by reason of mental retardation or a physical handicap, who was incapacitated and covered under this plan on the child's 25th birthday and who continues to be incapacitated beyond the child's 25th birthday.

Covered expense: Class I, II, III Services are payable per Schedule
Deductible: $50 Combined Deductible for classes I, II and III each year. Deductible is waived on 2 cleanings per year (Prophylaxis 01110 & 01120.)
Waiting Period: Class I: Immediate, Class II: 90 days, Class III: 12 months

Designations:

Class I - Preventive Services
Class II - Basic Services
Class III - Major Services

Benefit Categories:

Preventive

• Exams
• Cleanings
• X-Rays
• Fluoride

Basic

• Fillings
• Simple Extractions
• Endodontics
• Peridontics
• Oral SurgeryDentures
• Bridge

Major

• Crown
• Bridge
• Dentures

Limitations and Exclusions: You must submit your claim form within 90 days of service to receive reimbursement.