Main Street America Insurance, Inc

How Secure DentalOne Plan Works

What is Secure DentalOne?

Secure DentalOne offers you access to quality, affordable dental coverage for your entire family. Coverage is provided for preventive, basic and major dental services per insured person as follows:

How are benefits covered?

Secure DentalOne pays benefits for each covered person in the following manner:

First, you meet the $100.00 Lifetime Deductible per covered person.

Then Secure DentalOne pays a percentage of covered expenses based on the Reasonable and Customary (R&C) fees for those Covered Expenses.

BasicOne* ClassicOne PremierOne Waiting Periods       Preventative 0 0 0 Diagnostic N/A 0 0 Basic N/A 6 months 0 Major N/A 12 months 0 Coinsurance     Graded Benefit Preventative 80% 80% 100% Diagnostic N/A 80% 100% Basic N/A 50% 25/50/75%** Major N/A 50% 10/20/40%** Office Co-pay N/A N/A $10 Deductible N/A $100 lifetime applies to all services $100 lifetime applies to all services Calendar Year Maximum N/A $750 $1250 *BasicOne option subject to PPO MAC pricing **Year 1/Year 2/Year 3

Preventive: Cleanings, exams, sealants, fluoride
Diagnostic: Bitewing X-rays, full mouth X-rays
Basic: Fillings, extractions, repairs
Major: Endodontics, Periodontics, Oral Surgery, Crowns, Bridges

Who is eligible for this coverage?

This plan is offered to members of CA and their spouse through age 64, and their eligible dependents (state requirements for dependent eligibility may vary).

When does my coverage start?

Coverage starts on the effective date. The effective date issued will begin on the first of the month (at12:00 a.m.) following HPA, Inc.’s receipt of the completed Enrollment Form and payment of the first month of premium.

What are my payment options?

You can pay Monthly through auto bank withdrawal or credit card. Quarterly or Annually can be paid by credit card.

What is the calendar year maximum?

The maximum amount payable for all Covered Dental Charges in any calendar year as shown in the Coverage Schedule. The Calendar Year Maximum will apply to each insured person.

Brief Statement of Policy Provisions Relating to Premiums, Renewability, and Termination
The Policy is renewable at the option of the Association or the Insurer. The Insurer reserves the right (subject to state specific requirements) to change the premiums upon 31 days prior to written notice.
Coverage may be terminated by the Policyholder or the Insurance Company upon 31 days written notice to the other party, and for other reasons stated in the group policy, such as: failure by the Policyholder to pay the required premium; if you are no longer eligible for this insurance; or you are no longer in an eligible class.

This website provides a brief description of the benefits, exclusions and other provisions of the Master Policy# SSL ADEN-POL 0606 issued to Communicating for America. For a complete listing, the Group Policy is available for inspection at the Policyholder’s offices. Benefits may vary in different states. Secure DentalOne may not be available in all states. All rights reserved. SSL Secure DentalOne Bro. 1-19-07