Dental (optional)

GeoCare International Special Group Insurance Program provides the insured member and family with a complete dental plan. This is an optional dental rider for Global Elite plan (zero deductible)

Dental Benefits and Rates effective March 1st, 2007

Subscriber only                                                           $36.00

Subs + spouse                                                            $72.00

Subs + children                                                           $66.00

Family                                                                         $120.00

Diagnostic & Preventive:                    Coinsurance                100%

Basic Services:                                    Coinsurance                80%

Major Services:                                   Coinsurance                50%

Maximum                                (All except Orthodontia)        $1,500

Orthodontia:                                       Coinsurance                50%

Orthodontia:                                       Maximum                    $1000 Life time

Dental Care

The expenses described in the 3 classes below are reimbursed subject to a Yearly maximum indicated in the Benefits Overview Matrix.

Preventative and Diagnostic Examinations Services

The Insurer pays the percentage of Covered Expenses shown in the Benefit Overview Matrix for preventative treatment and necessary diagnostic examinations. Covered Expenses include:

1. Regular oral examinations and regular x-rays;

2. Regular teeth cleaning;

3. Fluoride applications for children under age 19;

4. Sealant and space maintainers for children under age 16.

Deductibles do not apply to Preventative and Diagnostic Examinations Services.

Basic Restorative, Endodontic, Periodontics, Prosthodontics

(Maintenance), and Oral Surgery Services

The Insurer pays the percentage of Covered Expenses shown in the Benefits Overview Matrix for basic restoration endodontic, periodontal treatments and oral surgery. Covered Expenses include:

1. Oral surgery and related anesthesia;

2. Amalgam fillings;

3. Extractions;

4. Endodontic treatment (including root canal therapy);

5. Periodontal treatment (gum disease);

6. Repair of crowns , in-lays, on-lays, bridgework and dentures.

Major Restorative and Prosthodontics (Installation) Services

The Insurer pays the percentage of Covered Expenses shown in the Benefits Overview Matrix for major restorative and prosthodontics (installation) services. Covered Expenses include:

1. Fixed bridgework;

2. Partial or full removable dentures;

3. Crowns;

4. Inlays, on-lays;

5. Gold fillings (only to the extent that the tooth cannot be restored with amalgam, silicate acrylic, or plastic restoration).

Major Restorative and Prosthodontics (Installation) Services are not covered during the first 3 months the Insured Person is covered.

Orthodontic Dental Care

Orthodontic Dental Care applies only if the Group has chosen Dental Care and Orthodontic Dental Care as shown in the Benefits Overview Matrix.

The Insurer pays the percentage of Covered Expenses indicated in the Benefits Overview Matrix for necessary orthodontic treatment subject to a specific lifetime maximum also shown in the Matrix. Once this lifetime limit is reached, the Insured Person has no right to any further orthodontic treatment benefits.

Orthodontic expenses are not covered during the first 3 months the Insured Person is insured.