|
November
15, 2006
Your
2007 Dental Coverage Just Got Better
Now
with Orthodontic Coverage and Enhanced PPO
Benefits
Dear Member,
You are currently enrolled in SAMBA's Dental
& Vision Care Plan. We are pleased to
inform you that for the fifth straight year,
there will be no increase in your 2007
premium. What's more, we have enhanced
our Dental and Vision Care Plan benefits
beginning next year. Both the DMO and
Alternate Plan options will include
Orthodontic coverage for Adults and
Children. Plus, under the Alternate Plan,
increased benefit levels will apply when you
visit a dentist participating in the Aetna
PPO network.
Both DMO and
Alternate Plan Options
Orthodontic Benefits – In 2007,
both plan options will include orthodontic
benefits, with no deductible, for Adults and
Children. The DMO plan option has no
lifetime maximum. The Alternate Plan option
has a $1,500 per person/per lifetime
maximum. Both options have a 12 month
waiting period from the date of your
enrollment in the Plan.
Alternate Plan
Option – Increased PPO Benefits
In-Network Benefits – In 2007, the
Alternate Plan option will include increased
benefits when you visit a dentist
participating in Aetna's PPO network.
In-network benefit levels will be increased
to 100% for preventative services, such
as office visits, teeth cleaning, and
X-rays. PPO benefits will be increased to
75% for Basic Services, such as amalgam
restorations, root canal therapy, and
periodontal treatments.
Enclosed is a brief summary of the 2007
SAMBA Dental and Vision Care Plan. More
detailed information will be mailed to you.
We are certain you will agree that the SAMBA
plan remains the best dental and vision care
choice for you and your family.
Sincerely,
Walter E. Wilson
Executive Director
Enclosure
Visit
our Web SIte at www.sambaplans.com
SAMBA's
2007 Dental and Vision Care Plan
SAMBA
Offers You Freedom of Choice!
We Have Two Plan Options to Choose From
Select the Plan Option that is Right for You
| Choose
the Dental Maintenance
Organization (DMO®) plan
and you'll generally pay
less out of pocket for your
dental services. Or choose
the Alternate plan option
that permits you to visit
any licensed dentist for
covered services. You can
even switch between plan
options – the choice is
always yours! |
|
2007
SAMBA Dental and Vision Care
Plan
Plan Summary |
|
DMO
Option |
Alternate
Option |
|
Primary
Care Dentist |
In-Network |
Out-of-Network |
| Coverage
Type: |
Plan
Pays |
Plan
Pays |
Plan
Pays |
| Preventative
(A) |
100% |
100% |
70% |
| Exams,
X-rays, and
teeth
cleaning |
|
|
|
| Intermediate/Basic
(B) |
100% |
75%* |
60%* |
| Fillings,
Root Canal,
Periodontal
Scaling,
Tooth
Extraction |
|
|
|
| Major
(C) |
60% |
50%* |
50%* |
| Crowns,
Dentures,
Bridge
pontics,
Inlay, and
Crown
Abutments |
|
|
|
| Annual
Maximum (per
person) |
No
limit |
$2,000 |
$2,000 |
| Orthodontic
(D) |
50% |
50% |
50% |
Adult
and Child
Coverage
Maximum
(per person)
Waiting
Period |
No
limit
12 Months |
$1,500**
12 Months |
$1,500**
12 Months |
| Vision
Care
Benefits |
| Routine
Eye
Examination |
$30 |
$30 |
$30 |
| Eye
Dilation |
$8 |
$8 |
$8 |
| Frames,
Lenses or
Contacts |
$100 |
$100 |
$100 |
| Vision
One®
discount
program |
Yes |
Yes |
Yes |
*
The
Alternate
Plan Option
has a $50
per person
($150 per
family)
Annual
Deductible
that applies
to coverage
type B &
C services.
** The
Alternate
Plan
Option's
orthodontic
benefit
maximum is
per
lifetime. |
|
Visit
SambaPlans.com for complete SAMBA Dental and
Vision Care Program details.
The
SAMBA Dental and Vision Care Plan is a non-FEDVIP
plan.
This is a summary of plan benefits and not a
complete description.
The Plan's Summary Plan Description governs. |
SAMBA
Home > Archive
