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Mutual Dental PreferredSM Insurance Policy
Mutual Dental ProtectionSM Insurance Policy

Outline of Coverage - DNT2 ()

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$ 

per month for ()

Add a Vision Rider for $  per month

Outline of Coverage - DNT5 ()

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$ 

per month for 68175 ()

Add a Vision Rider for $  per month

Issue Ages

19-99

19-99

Calendar Year Deductible

$0 per year
for preventive services

$50 per year
for basic and major services

$100 per year
for all services combined

Preventive Services

The percentage the plan pays for:

  • Two cleanings per year
  • X-rays

100%
Insured pays nothing

100%
Insured pays nothing

Basic Services

The percentage the plan pays for:

  • Fillings
  • Extractions
  • Emergency treatment

80%
Insured pays 20%

50%
Insured pays 50%

Major Services

After a 12-month waiting period, the percentage the plan pays for:

  • Crowns
  • Dentures
  • Bridges
  • Root canals
  • Periodontics
  • Oral surgery

50%
Insured pays 50%

50%
Insured pays 50%

Calendar Year Benefit

The maximum amount the policy pays each calendar year for all covered services

$1,500

$1,000

Lifetime Maximum Benefit for Implants

The maximum amount the policy pays for dental implants

$3,000

$2,000

Out-of-Network Benefits

Charges are paid at the 80th percentile of the average cost of service in the customer's area. Customer then pays the difference to the dental provider.

The amount Mutual of Omaha pays is limited to the in-network discounted fee schedule meaning a dentist can balance-bill the customer the difference.

Vision Care Rider

The Vision Benefits rider may be added to either dental insurance policy. This rider provides a reimbursement benefit that pays for:

  • Eye Exams: Up to $50 every calendar year for one eye exam (no waiting period)
  • Eyeglasses and Contact Lenses: Up to $150 every two calendar years for eyeglasses or contact lenses (after a six-month waiting period)
Here’s how it works:
  • No Provider Network - Policyholders can see the vision care provider of their choice
  • No Waiting Period for Eye Exams - There's no waiting period for eye exams. Following a six-month waiting period, policyholders are eligible for benefits for eyeglasses and contact lenses
  • Reimbursement Benefit - The rider reimburses the policyholder up to the maximum benefit. Amounts in excess of the maximum are the policyholder’s responsibility
  • Submitting a Request for Reimbursement - After paying for an eye exam, glasses or contact lenses, the policyholder can submit a request for reimbursement by emailing a qualified proof of the expense (itemized receipt, explanation of benefits or other document that records the expense) to vision.claims@mutualofomaha.com. The request also can be faxed to 402-997-1869 or they can call 800-775-1000 and select the vision benefits claims option.
  • Works with Other Vision Care Benefits - The Vision Care Benefits rider can be used in conjunction with any other vision care benefit or discount the policyholder may have.
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