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Summary
of Benefits
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Vantage Choice
Co-Insurance Plan (1)
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In-Network
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Out-of-Network(2)
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Preventative
Office visit, cleaning, oral exam and
x-rays
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Basic
Simple
extractions and fillings
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80%
30%
discount in waiting period
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60% |
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Major
Crowns,
bridges, dentures, inlays,
periodontics, endodontics and oral
surgery
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50%
25%
discount in waiting period
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40% |
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Orthodontics
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Waiting Periods
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6 months basic / 12 months major |
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Deductible
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$50 per subscriber per calendar
year
for basic and major services |
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Annual Maximum
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$1,000 per subscriber |
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Additional Information
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For subscribers ages 65 and older
there is a $25 office co-pay and $100
deductible per subscriber per calendar
year.
TDA PPO Network
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Payment Method
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All Plans allow Monthly payments by
Visa, MasterCard, Discover, American
Express or automatic bank account
withdrawals.
Vantage Care and Vantage Access
Plans offer more savings with a
discounted annual payment rate.
There is a one-time enrollment fee
of $10.00 for all new applications.
Please include it with your first
month premium payment.
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$21.42
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Subscriber + 1
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$40.71
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Subscriber + 2
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$53.56
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Subscriber + 3
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$66.42
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Subscriber + 4
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$79.27
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Subscriber + 5
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$92.13
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Subscriber + 6 or more
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$115.48
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(1)
Vantage Choice Plan insured by
American National Life
Insurance Company of Texas,
Galveston, Texas. (2)
All payments made by the plan
are based on the network fee
schedule. For complete details
of the coverage please refer
to the plan certificate. Plans
may vary by state.
Vantage Choice dental
insurance policy issued under
form series DENT06-POL.
Available to members of the
National Consumers Advantage
Association (NCAA). The
benefits illustrated are a
summary only; these policies
have exclusions and
limitations.
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