IBSi Dental Choices

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We've created a great plan to fit any employer’s budget. IBSi Dental Choices is a traditional indemnity
plan that may be sold on an employer sponsored or voluntary basis. All coinsurance percentages are
based on Usual, Reasonable and Customary fees for services in your area. For more information
about IBSi Dental Choices, please contact your sales representative.

Eligible Benefits
PREVENTIVE Cleanings ~ 1 per 6 months Exams ~ 1 per 6 months Flouride Space Maintainers	100% No Deductible No Waiting Period
DIAGNOSTIC Bitewing X-rays ~ 1 per 12 months Full mouth X-rays ~ 1 per 36 months	100% No Deductible No Waiting Period
BASIC Filings Extractions Repairs Endodontics¹ Periodontics¹ Oral Surgery¹	80% Deductible Applies No Waiting Period
MAJOR Crowns Bridges Implants Dentures Other Prosthetics Repair	50% Deductible Applies 12 Month Waiting Period2
ORTHODONTIA	50% $500—$2,000 lifetime benefit
DEDUCTIBLE	$25 or $50 calendar year or $100 lifetime
CALENDAR YEAR MAXIMUM	$500—$2,000

Rate Guarantee

12 Months—Standard
24 Months—Optional

Participation

Minimum of five (5) insured employees with no minimum participation percentage required. If 75% enroll, excluding waivers for coverage elsewhere, premium rates will be discounted.

¹ Endodontics, Periodontics, & Oral Surgery may be moved to MAJOR services at a lower premium.
² The MAJOR services waiting period may be waived for “takeover” groups.

Alternative Plan Choices

In addition to the 100/80/50 plan shown above, other plan choices are available. They include: 100/90/60; 100/85/50; 100/80/25; 100/80/0; and, 100/0/0 Dual or Triple option benefit plans are available for all size groups.

Note: Competitive plans are also available for employer groups with 100 or more employees.