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Table of Benefits – Dental Plan Applicable to new registrations or renewals on/or after 1st June, 2013. This Table of Benefits must be read in conjunction with the DentalCover.ie Rules – Terms and Conditions. The Voluntary Health Insurance Board trading as Vhi Healthcare and DentalCover.ie is regulated as an intermediary by the Central Bank of Ireland. DeCare Dental Insurance Ireland Limited trading as DentalCover.ie underwrites this product and is regulated by the Central Bank of Ireland. Vhi Healthcare is tied to DeCare Dental Insurance Ireland Limited for Dental Insurance. Benefit Provision Benefit Limit Section 1 - Investigative and preventive treatment – no waiting period Examinations Two times per calendar year Scaling and polishing 100% 100% Two times per calendar year Radiographs (x-rays) Bitewings coverage - 1 series per 12 month period for insured persons up to the age of 18 100% years - 1 series per 24 month period for insured persons over 18 years Full Mouth (Complete Series) or Panoramic 100% Covered once per 60-month period Periapical(s) 100% 4 single x-rays are covered per 12-month period Occlusal 100% 100% 2 series per 24-month period Section 2 - Basic treatment – 3 month waiting period applies Restorations (fillings) Once per tooth surface per 24 month period Pre-fabricated or Stainless Steel Crowns 70% Once per tooth per 60-month period for eligible dependant children up to the age of 19 Sealants 70% Once per tooth per lifetime for permanent first and second molars of eligible dependant children up to the age of 16 Space Maintainers 70% Once per tooth per lifetime on eligible dependant children up to the age of 17 for extracted primary posterior (back) teeth Periodontal Treatment 70% Periodontal scaling and root planing - Once per quadrant per 36 month period Full mouth debridement - Once per tooth per lifetime Periodontal maintenance - Once per 24 month period Tooth extractions 70% Simple tooth extraction - Once per tooth per lifetime Emergency Treatment 70% 100% Once per 12 month period for the immediate, temporary relief of pain or infection Denotes benefit changes to this plan. 70% 70% Dental Plan Emergency treatment is NOT subject to the 3-month wait period Section 3 - Major treatment – 12 month waiting period applies Policy Excess Endodontic Therapy on Primary Teeth €100 Pulpal therapy - once per tooth per lifetime Theraputic pulpotomy - once per tooth per lifetime Endodontic Therapy on Permanent Teeth 50% 50% Root canal therapy - once per tooth per lifetime Prosthetic Services - Dentures 50% 25% 25% Reline and rebase - 1 per 24 month period Repairs, replacement of broken artificial teeth, replacement of broken clasp(s) - 1 per 6 month period Denture adjustments - 2 times per 12 month period Removable prosthetic services (Dentures) - once per 5 year period Prosthetic Services – Bridge and Implant Supported Crowns 25% 25% No cover No cover 50% 50% €500 Bridge services Implant supported crowns Crowns, Inlays and Onlays Permanent crowns, inlays and onlays - once per tooth per 5-year period Crown repair – once per tooth per 12 month period A separate annual maximum of €500 per period of insurance applies to crowns, inlays and onlays. Section 4 – Orthodontics Orthodontic treatment If covered less than 2 years on Dental Plan If more than 2 continuous years cover on Dental Plan - €500 lifetime orthodontic benefit for each covered person No cover €500 Section 5 – Annual maximum This applies to all sections of your plan (excluding crowns, inlays and onlays which has a separate maximum of €500). Maximum benefits may not be carried over to future years of cover. Year 1 & 2 continuous insurance on Dental Plan Year 3 & 4 continuous insurance on Dental Plan* Year 5+ continuous insurance on Dental Plan** * A loyalty benefit will apply at the start of your third continuous year on Dental Plan when the annual maximum available for each covered person will increase by €200, the annual maximum on your plan will be €1200 ** A loyalty benefit will apply at the start of your fifth continuous year on Dental Plan when the annual maximum available for each covered person will increase by €300, the annual maximum on your plan will be €1500 TOBDP V9 Jun13 €1,000 €1,200 €1,500