Index | Benefits | Exclusions & Limitations | Provider Network | Quote & Apply

Oregon Dental Insurance approved in minutes!

What is Madison Dental?
Madison Dental offers you access to high quality, affordable dental coverage for your entire family. Coverage is provided for preventive, diagnostic, basic and major dental services.

Quality Dental Insurance Coverage

Preventive Care

• Routine oral exams – limited to two per calendar year
• Prophylaxis (the cleaning and scaling of teeth) – limited to two per calendar year
• Topical application of fluoride – for dependent children under age 19; limited to one per calendar year (not applicable in all states)

Diagnostic Care

• Intra-oral occlusal film
• Bitewing X-rays (up to a set of four) – limited to one per calendar year
• Full-mouth X-rays (panoramic film or full series) – no less than 36 months apart

Basic Care

• Simple extraction
• Pin retention – per tooth, in addition to restorations
• Fillings (restorations)
  • Amalgam restorations
  • Composite restorations
  • limited to anterior teeth and bicuspids
  • Sedative fillings
• Antibiotic injections administered by a dentist
• Maintenance Prosthodontics
  • Denture repairs/adjustments
  • Denture rebase – no less than 24 months apart
  • Denture reline – no less than 24 months apart

Major Care

• Endodontic treatment
• Periodontic services
• Inlays, onlays and crowns
• Prosthetic services (dentures or bridges)
• Oral surgery

1 Out-of-network charges in excess of the network fee, or maximum allowable charge (MAC), are the responsibility of the insured person.
2 Claims reimbursement is subject to usual, customary and reasonable charges.

What is OrthoCare?
ORTHOCARE PROGRAM REDUCES THE COST OF ORTHODONTIC TREATMENT The OrthoCare Orthodontic Discount Program is a program for orthodontic care. When using a contracted OrthoCare Orthodontist, you could save up to 20% on the services performed. This results in meaningful savings when compared to the Usual and Customary (UCR) fees charged by Orthodontists. HIGHLIGHTS No Deductibles No Waiting Periods No Claim Forms No Prior Authorization Required Afordable Rates Coverage for Children and Adults ELIGIBILITY The OrthoCare program has been designed to offer orthodontic benefits to both individuals and families, providing benefits for the routine orthodontic treatment for children and adults. Children who are dependents are covered under the family plan up to their 23rd birthday. OrthoCare has no waiting periods before the benefits begin.

Where can I find a listing of participating orthodontists?
Visit our web site http://www.amdps.com

• No Deductibles
• No Waiting Periods
• No Claim Forms
• No Prior Authorization Required
• Affordable Rates
• Coverage for Children and Adults

*The optional Orthocare Program is not an insurance benefit, nor is it affiliated with Madison National Life Insurance Company or a part of the Madison Dental insurance plan. This program is NOT a health insurance policy and the program does not make payments directly to the providers of health services. This program provides discounts at certain locations for health services. The program member is obligated to pay the provider for all the health care services that the member will receive, but the member will receive a pre-negotiated discount from the providers listed in the network, in accordance with the specific pre-negotiated discounted fee schedule. This program does not guarantee the quality of the services or procedures offered by the providers. Discounts vary by provider. The Discount Medical Plan Organization that operates this program is American Dental Professional Services, LLC located at 9054 N. Deerbrook Trail, Milwaukee, WI 53223.

Eligibility
Individuals, their spouse and dependent children are eligible for coverage. In order to be considered an eligible dependent child, he/she must be unmarried and under age 19, or 25 if a full-time student. The primary insured must be a member of CA and all family members must be residents of the United States in order to be covered.

Covered Charges
Covered charges must be incurred while the policy is inforce and the person is covered by the policy. To become a covered charge, the dental services must be performed by: a licensed dentist performing dental services within the scope of his license; or a licensed dental hygienist acting under the supervision and direction of a dentist. A covered charge is considered incurred on the following dates: for full and partial dentures–on the date the final impression is taken; for fixed bridges, crowns, inlays and onlays–on the date the teeth are first prepared; for root canal therapy–on the date the pulp chamber is opened; for periodontal surgery–on the date surgery is performed; for all other services–on the date the service is performed.

Alternative Benefit
If we determine that a less expensive alternate procedure, service or course of treatment can be performed in place of the proposed treatment to correct a dental condition and the alternative treatment will produce a professionally satisfactory result, then the maximum we will allow will be the charge for the less expensive treatment.

Predetermination of Benefits
Except in an emergency, before you begin treatment that will cost more than the predetermination amount shown on the Certificate’s schedule of benefits page, your dentist must submit a claim to us describing the treatment necessary and its cost. This estimate is not a guarantee of payment. We will still consider a claim for which you have not obtained prior approval. However, the claims will be subject to reduced benefits based on our determination of reasonable and customary charges, and medically necessary treatment.

When does my coverage start?
Coverage starts on the effective date. The effective date issued will begin on the 1st of the month (at 12:00 a.m.), following GroupLink’s receipt of the completed Enrollment Form and payment of the first month of premium.

Madison Dental Partners

Madison National Life Insurance Company, Inc.
In all states except New York and New Hampshire, Madison Dental is underwritten by Madison National Life Insurance Company, Inc. (MNL), a Wisconsin insurance company. Madison National is a member of The IHC Group. Madison National is rated A- (Excellent) by A.M. Best Company, a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet their obligations.

Group Association
Madison Dental is a group association dental plan available to individuals and families. Membership enrollment in Communicating for America, Inc. (CA) is effective upon receipt of association dues, which are added to the plan premium. Communicating for America is a nonprofit association headquartered in Fergus Falls, Minn., providing members valued benefits and savings since 1972.