The Elite PPOPremium offers maximum access to dentists and greater coverage.
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 sent to you with your membership card.
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. Please see the Plan Comparison chart for more information.
There are no waiting periods for Class I services. There is a 6-month waiting period for Class II services and a 12-month waiting period for Class III services.
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 participating dentist in the Elite PPO network.
ELITE PPO PREMIUM benefits include
NO CHARGE for routine semiannual cleanings
NO CHARGE for oral examinations
NO office visit charge
$50 DEDUCTIBLE per member
$1,500 ANNUAL MAXIMUM per person
account for over 65% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.1
ACCESS TO OVER 300,000
ELITE PPO PREMIUM: KIDS
By enrolling in the Elite PPO Premium, dependents under the age of 19 will automatically be enrolled in our pediatric dental plan. Review covered procedures.
1 Dominion National - based on annual review of utilization data. 2 Dominion National Internal Performance Report, November 2017. Participating providers are subject to change.