Dental Benefit Summary

this dental benefit is sure to make you smile

• No Charge for Oral Exams
• No Charge for Cleanings
• No Charge for X-Rays
• No Charge for Most Fillings
• No Charge for some Root Canals
• Other Procedures at greatly reduced rates
• Benefits improve the longer you stay enrolled

Benefits are available only at the plan’s participating dental offices. You choose from among our network of over 3,500 general dentists and specialists throughout New York State. To find a dentist by zip code click here.

Your participating provider will submit claims on your behalf.

Any service that is not covered can be rendered by any participating provider at the significantly reduced Healthplex PPO Schedule of Member Payments.

Individual Deductible for certain listed services*:
         · $50.00 year one
         · $25.00 year two
         · $0.00 year three

Family Deductible for certain listed services*:
         · $150.00 year one
         · $75.00 year two
         · $0.00 year three

Individual Maximum Benefit: $2,000.00 (annually)

* Procedures with an asterisk (*) in the payment schedule are subject to a low deductible.

Contact our Customer Service Department with questions about “Club "A" Dental Plan” at 800-468-0466.
Mon – Fri 9:00 AM - 5:00 PM EST