The Independence Voluntary Dental Plan

Voluntary Group Dental Insurance

Groups as Few as One Life

No Participation Requirements

Clients can Choose any Dentist

Optional 24-month rate guarantee

Takeover benefits for groups of 5 or more

100% Usual, Reasonable, and Customary Benefits

No Deductible

TYPE I – PREVENTIVE SERVICES

Periodic Oral Exams, Prophylaxis, Fluoride Treatment, Sealants, Space Maintainers and Harmful Habit Appliances

80% Usual, Reasonable, and Customary Benefits

6 Month Waiting Period

TYPE II – BASIC SERVICES

X-Rays, Fillings, Simple Extractions and Palliative Treatment

50% Usual, Reasonable, and Customary Benefits

12 Month Waiting Period

TYPE IIIA – MAJOR SERVICES

Endodontics, Periodontics (Treatment of Gum Disease) including Periodontal Cleanings,

Oral Surgery (other than simple extractions), Recementation of Crowns and Bridges and Denture Repairs.

50% Usual, Reasonable, and Customary Benefits

24 Month Waiting Period


TYPE IIIB - MAJOR PROSTHETIC SERVICES

Inlays, Onlays, Crowns (including stainless steel and resin crowns), Dentures and Bridges

$50.00 Per Year

Per Family Member

Annual deductible applies only to:

TYPE II – BASIC SERVICES

TYPE IIIA – MAJOR SERVICES

TYPE IIIB – MAJOR PROSTHETIC SERVICES

$1,000
POLICY YEAR MAXIMUM – Per person per policy year. Applies to all types of services.

Terms: Sole proprietorships, partnerships, or corporations with at least one (1) full-time employee, including active, full-time owners or partners, are eligible.

Employees: All active, full-time employees working at least 20 hours per week, including active, full-time owners or partners are eligible. Those employed on the date the firm becomes insured are eligible on that date. New employees hired after that date are eligible after a waiting period selected by the employer.

Dependents: Eligible dependents include the insured employee’s spouse and unmarried children prior to their 19th birthday who do not work for the firm. In addition, unmarried children from their 19th birthday to the day before their 24th birthday are eligible if they are primarily dependent upon the employee for more than 50% of their support and maintenance and are listed as dependents on the employee’s Federal tax return.

Usual, Reasonable, and Customary Benefits: Benefits are based on the Usual and Customary fee, as determined by Gerber Life, in the area in which the Dentist practices.

Signing up for the Independence Dental Plan has never been simpler. After reviewing the benefits listed below, your client simply follows these three easy steps to find their rates:
Step 1: Look for client's zip code on the Step 1 sheet: Using the first three numbers of the client's zip code, scroll down the list of states and zip codes to find their zip code using the first three digits. (Example: If your client lives in Pennsylvania with zip code 17100 then they would use Area C rates.)

Step 2 - Find your client's SIC code on the chart provided under Step 2. (Example: A truck driver would fall under SIC rate two)

Step 3 - Take your Area letter and cross-check it with the SIC rate number to find the price per adult and child. (In the example above - a real estate agent in Pennsylvania zip code 17100 would pay $20.11 for an adult and $12.44 for a child.

Please feel free to call us if you have any questions regarding this process. We are here to help you sell The Independence Dental Plan conveniently and efficiently.

Step 1: Find your zip code area (using the first 3 numbers)

The Independence Plan is approved in the following states:

(More States will be added each week.)

ALABAMA B
ARIZONA D
ARKANSAS B
CALIFORNIA
900-902, 904, 914 H
916, 940-944, 947 H
903, 905, 907, 912, 913 G
915, 926, 945, 948-951, 954 G
906, 908, 910, 911, 914 F
918-922, 927, 928, 930 F
933-937, 946, 952, 955, 958-961 F
All other ZIP codes E
COLORADO
800-804, 808-810 D
All other ZIP codes C
DISTRICT OF COLUMBIA
G
DELAWARE
197, 198 E
199 C
HAWAII D
IDAHO
837, 838 C
All other ZIP codes B
KANSAS
B
KENTUCKY
405-409, 412, 414-418, C
421, 422, 425, 426 C
All other ZIP codes B
MASSACHUSETTS
010-015 D
017-020, 023-027 E
016, 021, 022 F
MISSISSIPPI B
MISSOURI
630, 631, 641 C
633, 640, 648, 652, 658 B
All other ZIP codes A
NEBRASKA A
NEVADA F
NEW JERSEY
070-074, 078, 079, 088, 089 F
075, G
077, 085-087 E
All other ZIP codes D
NEW MEXICO C
OHIO
420, 423, 424, 430 B
434-436, 440, 442-445 B
447, 449, 450-455 B
432, 441 C
All other ZIP codes A
PENNSYLVANIA

171, 174, 176, 180, 181, 196 C
189-194 D
All other ZIP codes B
RHODE ISLAND D
SOUTH CAROLINA B
SOUTH DAKOTA A
TEXAS
750, 787, 798 D
752, 753 F
754-763, 767, 773-775 C
780, 782-785, 790-794, 797 C
770 E
All other ZIP codes B
WEST VIRGINIA

247-249, 253, 258, B
259,262,266-268 B
All other ZIP codes A
WISCONSIN

532, 534, 537 C
All other ZIP codes B
WYOMING
B

Step 2: Find your SIC codes.

SIC Rate One

01XX - Agriculture, Forestry and Fishing
09XX
10XX - Mining
14XX
22XX Textile Mills
24XX Lumber and Wood

SIC Rate Two

15XX General Contractors
16XX Heavy Construction
17XX Special Trade Contractors
20XX Food Products
21XX Tobacco
23XX Apparel and Other Textile Products
25XX Furniture
26XX Paper and Allied Products
28XX - Chemicals, Petroleum and Coal
29XX
30XX Rubber and Plastics
31XX Leather
32XX Stone, Clay, Glass and Concrete
33XX Metals
34XX Fabricated Metals
35XX Machinery
37XX Transportation Equipment
42XX Trucking and Warehousing
44XX Water Transport
46XX Pipeline Transport
49XX Electric, Gas and Sanitary Services

SIC Rate Three

27XX Printing
36XX Electrical Equipment
39XX Miscellaneous Manufacturing
40XX- Railroad and Local Pass. Transit
41XX
43XX US Postal Service
48XX Communication Services
50XX Wholesale Trade - Durable Goods
51XX Wholesale Trade - Non-Durable Goods
52XX Retail Trades - Building Materials
53XX - 57XX Retail Trade - General Merchandise
Retail Trade - Food
Retail Trade - Auto
Retail Trade - Apparel
Retail Trade - Furniture
70XX Hotels
72XX Personal Services
75XX Auto Repair & Garage
76XX Repair Services

SIC Rate Four

38XX Instruments
45XX Air Transport
47XX Transportation Services
58XX Retail Trade - Restaurants
59XX Retail Trade - Miscellaneous Stores
60XX Banks
61XX Credit Agencies
62XX Brokers
63XX Insurance Carriers
65XX Real Estate Agents
73XX Miscellaneous Services
83XX Social Services
84XX Museums and Zoos
88XX Private Households
93XX Public Finance
94XX - Administration, Human Resources, Economic and Housing
96XX

SIC Rate Five

0XX Medical Services
64XX Insurance Agents
66XX Real Estate and Insurance
67XX Holding Investment Companies
81XX Legal Services
82XX Educational Services
86XX Non-Profit Organizations
87XX Engineers and Accountants
89XX Miscellaneous Services
91XX Executive, Legislative and Government
92XX Courts, Police, Legal, & Fire Dept

Step 3: Find your Monthly Rate

ADULT - SIC GROUPS
AREA ONE TWO THREE FOUR FIVE
A $13.95 $15.64 $16.91 $18.17 $20.29
B $15.94 $17.87 $19.32 $20.77 $23.18
C $17.93 $20.11 $21.74 $23.37 $26.08
D $19.92 $22.34 $24.15 $25.96 $28.98
E $21.92 $24.57 $26.57 $28.56 $31.88
F $23.91 $26.81 $28.98 $31.15 $34.78
G $25.90 $29.04 $31.40 $33.75 $37.68
H $27.89 $31.28 $33.81 $36.35 $40.57

CHILD - SIC GROUPS
AREA ONE TWO THREE FOUR FIVE
A $8.63 $9.67 $10.46 $11.24 $12.55
B $9.86 $11.06 $11.95 $12.85 $14.34
C $11.09 $12.44 $13.45 $14.46 $16.14
D $12.33 $13.82 $14.94 $16.06 $17.93
E $13.56 $15.20 $16.43 $17.67 $19.72
F $14.79 $16.58 $17.93 $19.27 $21.51
G $16.02 $17.97 $19.42 $20.88 $23.31
H $17.26 $19.35 $20.92 $22.49 $25.10

Notes:
1 Rates are unisex.
2 Rates vary by area and by SIC Code.
3 Adult rates do not vary by age.
4 The Adult rate applies to each insured employee, spouse and child who is age 19 or older.
5 The Child rate applies to each insured child who is at least age 3 and under the age of 19.
6 The rates shown above apply to new groups with effective dates from July 1, 2001 through December 31, 2001, inclusive. These group rates are subject to change every six months beginning January 1, 2002.
7 Initial rates are guaranteed for 12 months for the group. A 24-month rate guarantee is available to virgin groups only at a load of 1.15 on the Adult and Child rate.

 

 

One SOURCE Insurance Brokerage

2235 Green Vista Dr. Suite, 310

Sparks, NV. 89431

(775)-674-4600 (800)-366-5226

Fax:(775)-674-4616

E-mail: info@onesourcenv.com

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