MAX Essentials
Essential coverage to keep your customers’ smiles healthy. MAX Essentials fully covers diagnostic and preventive services, including 50% coverage for basic services like fillings.
| Plan Pays | In-Network | Out-of-Network |
| Diagnostic and Preventive | 100% | 100% |
| Basic and Minor Services | 50% | 50% |
| Major Services | 0% | 0% |
| Orthodontics | 0% | 0% |
| Annual Maximum | $750 | $750 |
| Annual Deductible (per person/per family) | $50/$150 | $50/$150 |
| Allowed Amounts | PPO Fee | PPO Fee |
NOTES: These summaries are samples of benefits. Dental plans have exclusions and limitations that may limit coverage. For complete coverage details, please refer to your Certificate of coverage, D-(state specific abbreviation, if applicable)-3502A v.4.
EXCLUSIONS: Cosmetic surgery or dentistry for aesthetic reasons (except reconstructive surgery for children because of congenital disease or anomaly); general anesthesia and/or intravenous sedation; treatment by anyone other than a licensed dentist or dental hygienist; veneers; sealants; periodontic services (to treat gum disease); endodontic services (root canals); prosthodontics (bridges, implants and dentures), oral surgery services (extractions and dental surgery); relines and repairs (to bridges and dentures); crown and cast restorations (metal and porcelain crowns); coverage for temporomandibular disorders (“TMD”); appliances; procedures and restorations for increasing vertical dimension, occlusion, tooth structure loss due to attrition, abrasion or erosion, or for periodontal splinting; orthodontic services; space maintainers; lost, missing or stolen appliances; services not in the Certificate of Coverage and/or Summary of Dental Plan Benefits.
LIMITATIONS: Coverage for services may be limited based on the age of the person receiving the services; coverage for certain services may be limited to a maximum number of occurrences during a specified time period (such as two times per year or one time every three years).
The premium rate will vary between plans. The Certificate of Coverage has a term of one year and will automatically renew (upon payment of required premium) unless terminated in accordance with its provisions. Coverage may be terminated for reasons stated in the Certificate of Coverage. Coverage ceases upon termination. Products and services referred to herein may not be available in all states or jurisdictions.
*Renaissance internal data, 2016