Voluntary IndemnityPlus Plans

High Plan

Medium Plan

Basic Plan

Calendar Year Maximum

Choose your level of benefits

$2,500

$2,000

$1,000

Class I Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, x-rays, sealants

100% coverage for
eligible expenses

100% coverage for
eligible expenses

80% coverage for
eligible expenses

Deductible

$0

$0

$0

Waiting period

No

No

No

Class II Basic Services

Fillings (amalgam, porcelain & plastic), anterior and posterior composites, anesthesia (general or intravenous sedation), emergency palliative treatment, space maintainers for children, pathology

90% coverage for
eligible expenses

80% coverage for
eligible expenses

80% coverage for eligible expenses

Deductible

$0, $25, $50, $75 or $100 per calendar year,
3 per family maximum

$0, $25, $50, $75 or $100 per calendar year,
3 per family maximum

$0, $25, $50, $75 or $100 per calendar year,
3 per family maximum

Waiting period

No

No

No

Class III Major Services

Crowns & gold fillings, inlays, onlays and pontics, implants, fixed bridges, complete & partial dentures

60% coverage for
eligible expenses

50% coverage for
eligible expenses

50% coverage for
eligible expenses

Deductible

Calendar year
deductible applies

Calendar year
deductible applies

Calendar year
deductible applies

Waiting period    

12 months, unless waived

12 months, unless waived

12 months, unless waived

Oral Surgery

Class II

Class II

Simple & surgical extractions under Class II, other oral surgery under Class III

Periodontics/Endodontics

Class II or Class III

Class II or Class III

Class II or Class III

Class IV Orthodontics (optional)

50% coverage for eligible expenses

50% coverage for eligible expenses

50% coverage for eligible expenses

Waiting period

12 months, unless waived

12 months, unless waived

12 months, unless waived

Child Only Benefit Maximum Availability

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum or $1,500 Lifetime with a $750 Calendar Year Maximum

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum or $1,500 Lifetime with a $750 Calendar Year Maximum

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum or $1,500 Lifetime with a $750 Calendar Year Maximum

Special Dental Accident Benefit covers injury to sound, natural teeth

$1,000 maximum per accident

$1,000 maximum per accident

$500 maximum per accident

Children’s Good Vision Benefit¹

Yes

Yes

Yes

Reimbursement Level

80th or 90th percentile

80th or 90th percentile

80th or 90th percentile