Dental Benefits - 3 Plans To Choose From Premier Plan Select Plan Secure Plan
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Features Premier Plan Select Plan Secure Plan
Freedom to Use Dentist of Your Choice N/A N/A N/A
$1,500 Annual Benefit Option √ √ N/A
100% Preventive Coverage Option √ √ N/A
Initial 12 month Rate Guarantee √ √ √
Includes Coverage for Seniors √ √ √
No Waiting Periods for Most Services √ √ √
Optional Vision Coverage N/A N/A N/A
PrimeStar Personal Dental Plans provide for an increased coinsurance level based upon each Benefit Year of coverage. Benefit Year begins with each insured's effective date and continues for 12 months. Each primary insured and dependent will have their own benefit year beginning with their specific effective date of coverage.

PrimeStar Personal Dental Plans will reimburse you for covered dental expenses based upon the Reasonable and Customary (R&C) fees for those covered expenses.

Class A - Preventive Services Premier Plan Select Plan Secure Plan
Initial & Periodic Exams (2 per year), Cleanings (2 per year), Fluoride Treatments (1 per year to age 16)
Benefit Year One 100% 75% 80%
Benefit Year Two 100% 85% 80%
Benefit Year Three and Each Benefit Year Thereafter 100% 100% 80%
Deductible - Lifetime per Insured $50 $50 $75
Waiting Period None None None

Class B - Basic Services Premier Plan Select Plan Secure Plan
X-rays, Fillings, Simple Extractions, Sealants (to age 16)
Benefit Year One 35% 25% 25%
Benefit Year Two 50% 35% 35%
Benefit Year Three and Each Benefit Year Thereafter 65% 50% 50%
Deductible - Each Calendar Year Per Insured* $50/year $50/year $75/year
Waiting Period None None None

Class C - Major Services Premier Plan Select Plan Secure Plan
Oral Surgery, Endodontics, Periodontics, Crowns, Bridges, Dentures
Benefit Year One 10% 10% 10%
Benefit Year Two 25% 25% 25%
Benefit Year Three and Each Benefit Year Thereafter 50% 50% 50%
Deductible - Each Calendar Year Per Insured* $50/year $50/year $75/year
Waiting Period None None None

Class D - Orthodontics Premier Plan Select Plan Secure Plan
(Not available in South Dakota)
Straightening of Teeth (for children under age 19)
Benefit Year One 0% N/A N/A
Benefit Year Two 0% N/A N/A
Benefit Year Three and Each Benefit Year Thereafter 50% N/A N/A
Deductible None N/A N/A
Waiting Period (Not Available in South Dakota) 24 Months N/A N/A

Plan Maximums Premier Plan Select Plan Secure Plan
Calendar Year Maximum for Classes A, B and C Combined $1,000 $1,000 $750
Calendar Year Maximum for Class C - Major Services $500 $500 $350
Calendar Year Maximum for Class D $500 N/A N/A
Lifetime Maximum Per Child for Class D $1,000 N/A N/A
* Class B & C Deductible is combined for each calendar year. A maximum of three (3) individual deductibles per family shall apply.
* OPTIONAL CALENDAR YEAR MAXIMUM INCREASE *$1,500 *$1,500 N/A
Calendar Year Maximum for Class C Major Services *$750 *$750 N/A
As an optional feature of Premier and Select Plans, you may increase your Calendar Year Maximum benefit, per individual to $1,500 for an additional monthly fee. If you elect this feature, your Calendar Year Maximum for Major Services (as a portion of the $1,500) will also be increased to $750 per individual. This feature is not available for the Secure Plan.

Optional Vision Benefits Rider Premier Plan Select Plan Secure Plan
(Not a Stand Alone Benefit // Not Available in Florida or South Dakota)
Class A - Vision Exams - 1 per year
Benefit Year One and Each Benefit Year Thereafter 85% 85% 85%
No Waiting Period
Class B - Lenses and Frames - 1 pair every 2 years
Benefit Year One and Each Benefit Year Thereafter 50% 50% 50%
15 Month Waiting Period
Class C - Contact Lenses - 1 pair every 2 years (in lieu of frames & lenses)
Benefit Year One and Each Benefit Year Thereafter 50% 50% 50%
15 Month Waiting Period
Deductibles
Calendar Year Deductible $50/year $50/year $50/year
Calendar Year Maximum for Classes A, B and C $150 $150 $150

Monthly Premiums Premier Plan Select Plan Secure Plan
Applicant $27 $24 $21
Applicant + Spouse $56 $49 $42
Applicant + Child(ren) $65 $51 $44
Applicant + Family $99 $80 $70
Optional $1,500 Calendar Year Increase $6 $6 N/A
Optional Vision Coverage    $6 $6 $6

Dental Benefits - 3 Plans To Choose From Premier Plan Select Plan Secure Plan
<–(restart with different zipcode) Buy Now Buy Now Buy Now


Your agent is - CAROL MARIE LABERGE
10901 RED CIRCLE DRIVE ::  MINNETONKA,  MN   55343 ::  ph (952)945-3519


Questions? Contact your agent or contact us at:
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