Elite PPO PREMIUM The Elite PPO Premium offers maximum access to dentists and greater coverage. Members may seek dental services from any licensed dentist or use a participating Elite PPO network dentist for greater coverage. When dental care is received and expenses incurred, payments will be made in accordance with the list of benefits and services in the Coverage Schedule that will be sent to you with your membership card. no charge for oral exams, cleanings, bitewing x-rays and other preventive services. More extensive care (fillings, dentures, crowns, root canals, periodontal care, oral surgery, etc.) is covered. Please see the Plan Comparison chart for more information. There are no waiting periods for Class I services. There is a 6-month waiting period for Class II services and a 12-month waiting period for Class III services. Dominion National members can save up to 43% by using an in-network dentist!1 In-network dentists agree to accept payments that are lower than their standard fees. Out-of-network dentists may charge above the amount covered by the Dominion plan, which will be balanced billed to you, the member. Click here for more information on in-network advantages and out-of-network balance billing. ELITE PPO PREMIUM benefits include NO CHARGE for routine semiannual cleanings NO CHARGE for oral examinations NO office visit charge $50 DEDUCTIBLE per member $1,500 ANNUAL MAXIMUM per person "NO-CHARGE" PROCEDURES account for over 65% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.2 ACCESS TO OVER 12,000 DENTISTS395% of members have access to 2 Elite PPO Plan dentists within 10 miles of their homes.3 ELITE PPO PREMIUM: KIDS By enrolling in the Elite PPO Premium, dependents under the age of 19 will automatically be enrolled in our pediatric dental plan. Review covered procedures. 1 Dominion National - Based on review of January-December 2022 national PPO claims data. 2 Dominion National - based on annual review of utilization data. 3 Dominion National Internal Performance Report, 2023. Participating providers are subject to change.
