Our Secure Choice Dental plans
keep you smiling.

Dental Treatment	Your Cost With the Secure Choice Plan	Average Retail Charges*
Periodic Oral Evaluation	No Charge	$49
Complete X-Ray Series, including Bitewings	$10	$133
Routine Cleaning - Adult (once every 6 months)	$10	$85
Silver Fillings - Two Surfaces	$30	$146
Crowns - Porcelain to High Noble Metal	$295**	$1,077

*The samples above demonstrate potential savings with the Secure Choice Plan and may not reflect your actual results. The Average Retail Charges were determined by “Company” claims analysis for the state of Ohio for the year 2019. The Retail Charges represent a mean average rounded to the nearest dollar representing what you may pay without the plan services. **Members are responsible for additional lab fees for these services.

The Plan Dentist you select may not perform all procedures listed. The copayments shown apply to those Plan Dentists who perform those services. Therefore, you are encouraged to discuss availability of the scheduled services with your Plan Dentist. See the Individual Copayment Schedule included with your new member packet for a full listing of copayments. Charges for procedures not listed on the Copayment Schedule that are performed by your Plan Dentist are not covered under the Secure Choice Plan.

Should you require dental services that your selected Plan Dentist is unable to provide, you may obtain those services from a Plan Specialist at a reduced rate. No referral is needed from your Plan Dentist in order for you to obtain services from a Plan Specialist. There is no applicable copayment schedule for Plan Specialist services. Instead, the following reductions off the Plan Specialist's normal retail charges apply to all services received from a Plan Specialist. A 15% reduction applies if the Plan Specialist is an endodontist. A 25% reduction applies if the Plan Specialist is any other type of specialist, including but not limited to an orthodontist. You are responsible for paying the entire reduced charge at the time the service is received, or in accordance with the Plan Specialist's billing procedures.

Payment for each service of a Non-Plan Dentist or Non-Plan Specialist (at the provider's normal retail charge) is your responsibility, except for limited Plan Benefits for covered dental Emergency Services for temporary pain relief.


Cosmetic dentistry
We understand the importance of your appearance. That's why we've included the cosmetic procedures of bleaching and veneers in your copayment schedule.

Orthodontic benefits
The Secure Choice Plan includes reduced fees on orthodontic procedures for children and adults. Plan orthodontists reduce their normal retail fees by 25 percent. Orthodontic services are available only in areas where we have plan orthodontists who provide these services. Orthodontic treatment begun prior to your plan effective date is not eligible for this benefit.

Specialist benefits
Should the services of a specialty dentist be necessary, you may seek treatment from any network plan specialty dentist. If an oral surgery specialty dentist, orthodontic specialty dentist, periodontic specialty dentist or pedodontic specialty dentist provides treatment, you will receive 25 percent off that specialty dentist's normal retail charges. For treatment by an endodontic specialty dentist, you will receive 15 percent off that specialty dentist's normal retail charges. Specialty dentist services are available only in areas where this plan has Plan Specialist(s). Please note that payment for a service performed by a non-plan specialty dentist is your responsibility.

More Information
A partial list of some commonly used dental treatments can be found in the plan brochure. This list shows you the potential savings with Secure Choice versus what you may pay without this plan.

Limitations and exclusions apply – please see the plan brochure for complete details.