aflac 1.800.99.aFlac (1.800.992.3522) DEEivymount.ss11.sharpschool.com/UserFiles/Servers/Server... · Aflac Dental doesn’t have precertification requirements. If the treatment is

A82ES75MD RC(7/11)

dental insurance DEE

Peace of Mind andReal Cash Benefits

aflac.com/social 1.800.99.aFlac (1.800.992.3522)

Underwrittenby:AmericanFamilyLifeAssuranceCompanyofColumbusWorldwideHeadquarters|1932WynntonRoad|Columbus,Georgia31999

DEEdental insurancePolicy Series A82000This brochure accompanies Schedule of Dental Procedures A82ES75SCHMD.

T E R M s y o u n E E D T o k n o w

covered Person : Covered Person includesanypersoninsuredunderthecoveragetypeyouappliedfor.

PleaseseetheScheduleofDentalProceduresforacompleteandcomprehensivedefinition.

Guaranteed-reneWaBle : The policy is Guaranteed-Renewableforyourlifetime,subjecttoAflac’srighttochangepremiumsbyclassuponanyrenewaldate.

Pol icy year MaX iMuM: ThePolicy Year Maximumisthetotal dollar amountofbenefitspayableperpolicy year, perCoveredPerson.

Wait inG Per iod : The Waiting Period is the period afterthe Effective Date of coverage for which benefits are notpayable. If thepolicy is reinstated,allCoveredPersonswillbesubjecttonewWaitingPeriodsbeginningwiththedateofreinstatement.Ifadependentisaddedbyendorsement,theWaitingPeriodforsuchdependentwillbeginontheEffectiveDateoftheaddition.TheWaitingPeriodwillvarybasedonthebenefitcategory.

w h aT i s n o T C ov E R E D

Aflac will not pay benefits for losses caused by or resultingfrom any procedure not shown on the Schedule of DentalProcedures;servicesthatarenotrecommendedbyadentistorthatarenotrequiredforthepreservationorrestorationoforalhealth; repairs todentalworkwithinsixmonthsof theinitial work; treatment received while outside the territoriallimitsoftheUnitedStatesor,ifoutsidetheUnitedStates,theterritoriallimitsoftheplacewhereyourpolicywasissued;ortreatmentreceivedpriortotheEffectiveDateofcoverageor

treatmentreceivedduringabenefit’sWaitingPeriod.

AflacwillnotpaybenefitsforservicesrenderedbyyouoramemberoftheimmediatefamilyofaCoveredPerson.

AflacwillnotpaybenefitswhenevercoverageprovidedbythepolicyisinviolationofanyU.S.economicortradesanctions.If the coverage violatesU.S. economicor trade sanctions,suchcoverageshallbenullandvoid.

Aflacwillnotpayanyclaim,bill,orotherdemandorrequestforhealthcareservicedeterminedtobefurnishedasaresultofareferralprohibitedby§1-302oftheHealthOccupationsArticle.

PleaseseetheScheduleofDentalProceduresforprocedure-specificlimitationsandexclusions.

AflacDentalpaysbenefitsforsevencategoriesofdentaltreatmentsandhundredsofprocedures.ThebenefitamountswithineachcategoryvarybasedontheprocedurereceivedandaresubjecttoaPolicyYearMaximum.BenefitamountsandthePolicyYearMaximumareperCoveredPerson.

BeneF it cat e Go r ies Wa it inG Per iod BeneF it aMounts

Preventive(WellnessandX-Ray) None $15–$25

FillingsandBasicServices 3Months $10–$225

PainManagementandAdjunctiveServices 3Months $25–$120

OtherPreventiveServices 6Months $15–$100

OralSurgery,GumTreatments,andProstheticRepair 6Months $20–$750

CrownsandMajorServices 12Months $15–$350

MajorProstheticServices 12Months $40–$450

Pol icy y e ar MaX iM u M $1,200

90%oF systeMic diseases,

including heart disease, have oral symptoms.4

4“WarningSignsintheMouthCanSaveLives,”AcademyofGeneralDentistry,October2008.

over

this B r ochure is For i llustrat ive PurPoses only. re F e r to the Pol icy For coMPlete deF in it ions, deta i ls, l iM itat ions, and eXclus ions.

For Mo re in F o r Mat ion aB ou t the B eneF its ava i laBle , Please see the schedule oF dental Procedures.aFlac her e in Means aMer ican FaMily l i Fe assurance coMPany oF coluMBus.

1“ThePublicSpeaksUponOralHealthCare:AnADAandCrest/Oral-BSurvey,”AmericanDentalAssociation,October2008.2SubjecttoapplicableWaitingPeriods.3Iftheapplicantretainsexistingdentalcoveragewithanothercompany,onlytheEssentialsplancanbeoffered.

smile. we’ve got you under our wing.®Millionsofpeoplebelieveasmileisthemostimportantphysicalattribute—moresothanhair,eyes,orfigure.1Thebestwaytomaintainorimproveyoursmileistobrushandflossyourteethdaily,visityourdentist,andapplyforanAflacDentalinsurancepolicy.

AflacDentalprovidesbenefitsforperiodiccheckupsandcleanings,X-rays,fillings,crowns,andmuchmore.It’syoursmileandyourpolicy;AflacDentalgivesyoucontrol.•you choose your dentist.BecauseAflacdoesn’tuseanetworkofdentists,youcangotoanydentistyouchoose.• you and your dentist choose the best treatment for you. Aflac Dental doesn’t have precertification

requirements.Ifthetreatmentiscoveredbyyourpolicy,youdon’tneedAflac’spermissiontoreceiveit.2

AflacDentalisdifferentfrommanyotherdentalplansyoumayhaveseen.• you know what you’re getting with aflac Dental.Theplanspellsoutthebenefitsforbothwellnessand

otherdiagnostic/treatmentservices.Therearenograyareas.Eachcoveredprocedurehasaspecificbenefitamount.• aflac Dental doesn’t have an annual deductible.Otherdentalplansmayrequireyou tomeetanannual

deductiblebeforebenefitsarepayable.• aflac Dental pays benefits regardless of any other plan.Evenifyouhaveothercoverage,you’llreceive

yourfullAflacbenefitamount.3

WithAflacDental’sannual Maximum Building Benefit,youcanreceiveevenmorebenefits.AflacwillincreaseeachCoveredPerson’sPolicyYearMaximumby$100aftereach12consecutivemonthsthepolicyisinforceuptoamaximumof$500perCoveredPerson.