The Elite PPOBasic offers maximum access and no waiting periods.
Members may seek dental services from any licensed dentist or use a participating Elite PPO network dentist for greater coverage.
When dental care is received and expenses incurred, payments will be made in accordance with the list of benefits and services in the Coverage Schedule that will be mailed to you with your membership card.
no waiting periods and no charge for oral exams, cleanings, bitewing x-rays and other preventive services.
More extensive care (fillings, dentures, crowns, root canals, periodontal care, oral surgery, etc.) is covered at increasing levels, progressing through years 1, 2 and 3 (please see the Plan Comparison chart).
Out-of-network dentists may charge above the amount covered by the Dominion plan, which will be balanced billed to you, the member. To ensure you do not receive additional out-of-pocket charges, visit a dentist in the Dominion Elite PPO network.
ELITE PPO Basic benefits include
NO CHARGE for routine semiannual cleanings
NO CHARGE for oral examinations
NO CHARGE for bitewing x-rays
$50 ANNUAL DEDUCTIBLE per member
$1,000 ANNUAL MAXIMUM LIMIT per person
THESE "NO-CHARGE" PROCEDURES
account for over 65% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.2
ACCESS TO OVER 290,000
ELITE PPO BASIC: KIDS
By enrolling in the Elite PPO Basic, dependents under the age of 19 will automatically be enrolled in our pediatric dental plan. Review covered procedures.