Dental, Vision and Hearing Select
This is a Limited Benefit Insurance Policy for Dental, Vision and Hearing Expenses.
The Importance of Dental | Vision | Hearing
Help maintain quality of life
Financial protection in unforeseen situations that are painful, inconvenient, and expensive
Basic Medicare does not cover dental, vision or hearing expenses
PRODUCTS HIGHLIGHTS
Individual ages 18 – 99
Family rates (include up to 3 children)
$0 or $100 deductible
(does not apply to Preventive Services)
Glasses, Contacts and Hearing Aid benefits
Guaranteed renewable for life*
Choose your dentist (in-network or out-of-network)
$1,000, $1,500, or $3,000 policy year maximum benefit
Orthodontia benefit
Guaranteed issue
* Subject to our right to change premiums.
Flexibility to choose . . .
Dental Only
Dental and Vision
Dental & Hearing
Dental, Vision & Hearing
Dental, Vision and Hearing Select from ManhattanLife was designed with you in mind. With the ability to choose specific benefits, you can customize a plan tailored to fit your needs.
26% of adults in the United States have untreated tooth decay.
46% of adults aged 30 years or older show signs of gum disease.
Plan
Benefits
Plan Benefits
Eligibility: Ages 18 – 99
Policy Year Maximum Benefit: $1,000, $1,500 or $3,000
Policy Year Deductible: $0 or $100 per person (does not apply to Preventative Services)
Dental Coverage
| In-Network | Out-of-Network | |
|---|---|---|
| Preventive Services • Dental Exams; 2 per year • Cleanings; 2 per year • Bitewing X-Rays; 2 per year • Fluoride treatment is for age 16 and under; 2 visits per year | 100% of contracted rate | 80% of UCR |
| Basic Services • Limited Oral Evaluation • Diagnostic Consultation • Emergency • Emergency Palliative Treatment • Panoramic X-Ray • Periapical X-Ray • Periodontal Non-Surgical Service • Basic Restorative Service • Filling • Basic Oral Surgery • Periodontal Service • Non-Surgical Extraction | 65% of contracted rate 1st yr. 80% thereafter | 65% of UCR 1st yr. 80% thereafter |
| Major Services • Major Restorative Service • Inlay/Onlay/Crown • Endodontic Service • Periodontal Service • Prosthodontic Service • Implants | 20% of contracted rate 1st yr 50% thereafter | 20% of UCR 1st yr 50% thereafter |
| All Other Medically Necessary Services (services not listed above) | 20% of contracted rate 1st yr. 50% thereafter | 20% of UCR 1st yr 50% thereafter |
| Orthodontia • Straightening of teeth (for all ages) • Lifetime max $1,5002 | Year 1 - N/A Year 2+ - 50% | N/A |
Vision Rider
| In-Network | Out-of-Network | |
|---|---|---|
| Vision Services • Eye Exam • Refraction • Single Lenses • Bifocal Lenses • Trifocal Lenses • Progressive Lenses | 60% of UCR 1st yr. 70% of UCR 2nd yr. 80% of UCR thereafter 1 per year |
|
| • Eyeglass Frame • Contact Lenses | $200 maximum per year | |
| • Anti-Reflective Lenses | $45; 1 per year | |
| • Polycarbonate Lenses | $40; 1 per year | |
| • Contact Lens Fitting Fee | $15; 1 per year | |
Hearing Rider
| In-Network | Out-of-Network | |
|---|---|---|
| Hearing Services • Hearing Exam • Hearing Aid and Necessary Repairs or Supplies | $750 maximum (per ear, per year) |
|
CAREINGTON NETWORK*
Clients can access the Careington Maximum Care PPO Dental Network. Use of network is
completely optional.
Policyholders can benefit from choosing a dental provider from the Careington Dental Network
Policyholders can also use the dentist of their choice, even if they are not part of the dental network
Network discounts may help extend the policy year maximum with reduced charges.
Careington can be contacted at (800) 290-0523.
Discounted fees to help your
dental benefits go further
dental benefits go further
Access to quality dentists all
around the country
around the country
100,000+
Dentists Nationwide
Dentists Nationwide
So while you can choose your own dentist, visiting a Careington dental network provider offers greater savings and discounts. Visit https://www1.careington.com/ to find a Careington dentist near you
* Subject to our right to change premiums.
Understanding How Your Benefits Work
Dental Coverage
| In-Network | ||||
|---|---|---|---|---|
| Peter goes to his Careington Network dentist for a regular check-up. Upon examination, the dentist realizes that Peter needs a filling. Luckily, Peter has a Dental Plan with ManhattanLife. He has met his $100 annual deductible. | ||||
| Procedure: | Provider Charge | e In-Network Cost | ManhattanLife Pays | You Pay |
| Dental Exam | $150 | $35 | 100% Preventative day one; $35.00 | $0 |
| Filling | $275 | $99 | 65% Basic day one; (of In-Network Cost = $64) | $35 ($99 - $64 |
| Total | $425 | $134 | $99 | $35 |
| Out-of-Network | ||||
| Peter chose not to use the Careington Network and instead goes to an out-of-network dentist for a regular checkup. Upon examination, the dentist realizes that he needs a filing. Peter has a Dental plan with ManhattanLife. He has met his $100 annual deductible. | ||||
| Procedure: | Provider Charge | e In-Network Cost | ManhattanLife Pays | You Pay |
| Dental Exam | $150 | $96 | 80% Preventative day one; (of Usual and Customary = $77) | $73 ($150 - $77) |
| Filling | $225 | $175 | 65% Basic day one; (of Usual and Customary = $114) | $111 ($225 - $114) |
| Total | $375 | $271 | $191 | $184 |
| *subject to the Usual and Customary charges based in zip code 77092 | ||||
Vision Rider
| Earl goes to the Eye Doctor for an eye exam and gets glasses. He has had a Dental + Vision plan with ManhattanLife for over a year and has met his annual deductible. | ||||
|---|---|---|---|---|
| Procedure: | Cost | ManhattanLife Pays | You Pay | |
| Eye exam | $60 | 70% year two $42 | $0 | |
| Eyeglass Frame | $250 | $200 maximum; $200 | $35 ($99 - $64 |
|
| Lenses | $115 | 70% year two $81 | $35 ($99 - $64 |
|
| Total | $$425 | $323 | $35 | |
| *subject to the Usual and Customary charges based in zip code 77092 | ||||
Hearing Rider
| After a 12 month waiting period Brian decides to get his hearing checked, as he’s noticed a progressive hearing decline. His ENT specialist recommends Brian get hearing aids to help relieve the hearing loss. Utilizing the hearing portion of the plan, his exam and devices would have been covered as follows: | ||||
|---|---|---|---|---|
| Procedure: | Cost | ManhattanLife Pays | You Pay | |
| Hearing Exam | $90 | $750 maximum per ear, per year: $90 | $0 | |
| Hearing Aids | $1,600 | $750 maximum per ear, per year: $1,500 - $90 (Hearing Exam) = $1,410 | $190 | |
| Total | $1,690 | $1,500 | $190 | |
| *subject to the Usual and Customary charges based in zip code 77092 | ||||
*For illustrative purposes only. Claims examples are subject to geographic region, out of network provider and usual & customary charges.
Dental, Vision & Hearing Select Monthly Rates*
Dental Coverage
| $1,000 Maximum Benefit | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| $0 Deductible | $100 Deductible | ||||||||
| Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family | Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family |
| 3 - 17 | $28.29 | 3 - 17 | $25.98 | ||||||
| 18 - 39 | $30.49 | $60.9 | $72.91 | $110.47 | 18 - 39 | $27.12 | $54.24 | $66.09 | $99.71 |
| 40 - 54 | $38.88 | $77.75 | $107.16 | $131.49 | 40 - 54 | $34.80 | $69.60 | $96.98 | $118.97 |
| 55 - 64 | $41.43 | $82.85 | $99.47 | $121.04 | 55 - 64 | $37.32 | $74.64 | $90.19 | $109.72 |
| 65 - 74 | $43.69 | $87.37 | $86.16 | $101.52 | 65 - 74 | $39.46 | $78.93 | $77.94 | $91.92 |
| 75 - 99 | $46.58 | $93.17 | $88.58 | $100.24 | 75 - 99 | $41.87 | $83.75 | $79.71 | $90.24 |
| $1,500 Maximum Benefit | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| $0 Deductible | $100 Deductible | ||||||||
| Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family | Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family |
| 3 - 17 | $30.10 | 3 - 17 | $27.78 | ||||||
| 18 - 39 | $32.41 | $64.82 | $77.56 | $117.50 | 18 - 39 | $28.92 | $57.84 | $70.59 | $106.45 |
| 40 - 54 | $41.48 | $82.96 | $114.20 | $140.15 | 40 - 54 | $37.24 | $74.48 | $103.74 | $127.26 |
| 55 - 64 | $44.32 | $88.65 | $106.24 | $129.28 | 55 - 64 | $37.32 | $80.08 | $96.65 | $117.58 |
| 65 - 74 | $46.91 | $93.82 | $92.45 | $108.87 | 65 - 74 | $42.49 | $84.98 | $83.87 | $98.87 |
| 75 - 99 | $50.21 | $100.42 | $95.42 | $$107.94 | 75 - 99 | $45.28 | $90.56 | $86.14 | $97.50 |
| $3,000 Maximum Benefit | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| $0 Deductible | $100 Deductible | ||||||||
| Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family | Age | Individual | Individual + Spouse** | Individual + Child(ren) | Family |
| 3 - 17 | $35.26 | 3 - 17 | $32.30 | ||||||
| 18 - 39 | $36.45 | $72.89 | $89.33 | $134.59 | 18 - 39 | $32.65 | $65.29 | $81.09 | $121.81 |
| 40 - 54 | $46.97 | $93.95 | $131.21 | $160.94 | 40 - 54 | $42.34 | $84.68 | $119.08 | $146.04 |
| 55 - 64 | $50.49 | $100.98 | $122.13 | $148.57 | 55 - 64 | $45.78 | $91.56 | $111.12 | $135.16 |
| 65 - 74 | $53.78 | $107.56 | $106.18 | $125.19 | 65 - 74 | $48.90 | $97.81 | $96.61 | $113.95 |
| 75 - 99 | $57.86 | $115.73 | $110.05 | $124.54 | 75 - 99 | $52.42 | $104.84 | $99.74 | $112.91 |
* In CA, Spouse or Registered Domestic Partner; In DC, Spouse, Domestic Partner, or Civil Union Partner; In OR, Domestic Partner.
* Subject to our right to change premiums.
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