3. Dental & Vision — Our Dental Choice Plus Plan
We sell the Dental Choice Plus & Vision plan, underwritten by Philadelphia American Life Insurance Company. This is a hybrid plan — real dental insurance plus a vision and hearing discount program bundled in at no extra cost.
How the Dental Coverage Scales
Coverage is not flat — it builds over time. Benefits increase each policy year, which is the key thing to understand and explain to clients.
|
Service Type |
Waiting Period |
Coverage: Yr. 1 / Yr. 2 / Yr. 3+ |
|
Diagnostic & Preventative (cleanings, X-rays) |
None |
100% / 100% / 100% |
|
Basic (Fillings & Simple Extractions) |
6 Months |
50% / 65% / 80% |
|
Major — Endodontic (root canals) |
12 Months |
0% / 25% / 50% |
|
Major — Periodontic (gum treatment) |
12 Months |
0% / 25% / 50% |
|
Major — Oral Surgery |
12 Months |
0% / 25% / 50% |
|
Major — Restorations (crowns, inlays) |
12 Months |
0% / 25% / 50% |
|
Major — Orthodontic & Prosthodontics |
12 Months |
0% / 25% / 50% |
|
Key Points to Know Co-pay is $25/visit (under 65) or $40/visit (65+), limited to 3 visits per person per calendar year. Standard plan: $1,500 annual max. Enhanced plan: $2,000 annual max. Orthodontic and Prosthodontics have a $1,000 lifetime max ($350/year per benefit). Cosmetic procedures (whitening, veneers) are excluded. Coverage is reimbursement-based — in or out of network. |
The main thing to communicate to clients: preventive care is covered immediately at 100%. The plan builds value over time — major work becomes covered starting in year 2 and reaches full benefit by year 3. Clients who stay on the plan long-term get the most out of it.
Vision & Hearing — Discount Program (Not Insurance)
Bundled with the dental plan at no extra cost through Careington International Corporation. These are discount programs, not insurance.
- EyeMed Vision Care — discounts on exams, eyeglasses, and contact lenses at providers nationwide including LensCrafters, Target Optical, JC Penney Optical, Pearle Vision, and independent optometrists
- National Lasik Network — LASIK discounts at locations nationwide; Lasik Plus offers a free LASIK exam
- HearPO — discounts on hearing exams and hearing aids nationwide; includes 1 year of free batteries (80 cells per hearing aid); lowest price guarantee
|
How to Position This to Clients The vision and hearing discounts are included — it costs them nothing extra. For clients who ask about vision coverage, EyeMed and VSP are the two main options to point them toward instead of a separate vision insurance policy. Most clients will find one of these covers what they need without the extra premium. |