Plan Benefits Denbrella Dental Plan Preventative Services e.g., exams, cleanings, X-rays Not included Member Responsibility Base Level amount member pays $300 per calendar year (Preventative costs do not count towards meeting the member responsibility) Plan Reimbursement Covered expenses are reimbursed 100% above base level $2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period) Network of providers No network, use any dentist Coordination of benefits Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program) Services not covered:ExamsCleanings (preventative)X-rays (bitewings; preventative)ImplantsTeeth whiteningOrthodontics (child and adult)Services covered: Fluoride (up to age 16)SealantsSpace maintainersFillingsSimple extractionsX-rays (panoramic & medically necessary)Oral surgeryRoot canals (endodontics)Gum disease treatment (periodontics)CrownsBridgesDentures

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Suggested Plan

$19 per month or $205 per year

Save 10% by paying annually!

Member only

Denbrella is not insurance. It is a pooling of consumer dollars to pay for basic and major services. Members pay a monthly membership fee per person in the household up to a 4 per person max cost. There is no limit to the number of household members, however members must be the primary person in the household, spouse, and/or any qualified dependents. Age limit of members is through age 64. There are no sign-up fees or annual membership fees.

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Suggested Plan

$39 per month or $420 per year

Save 10% by paying annually!

Member +1

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Suggested Plan

$79 per month or $850 per year

Save 10% by paying annually!

Family

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Applicant Information

Name*

First Last

Birth Date*

Gender*

Marital Status*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Secondary Phone Number

Review & Confirm Payment Plan

Suggested Plan

$19 per month or $205 per year

Save 10% by paying annually!

Member only

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Suggested Plan

$39 per month or $420 per year

Save 10% by paying annually!

Member +1

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Suggested Plan

$79 per month or $850 per year

Save 10% by paying annually!

Family

Plan Details

Plan Benefits	Denbrella Dental Plan
Preventative Services e.g., exams, cleanings, X-rays	Not included
Member Responsibility Base Level amount member pays	$300 per calendar year (Preventative costs do not count towards meeting the member responsibility)
Plan Reimbursement Covered expenses are reimbursed 100% above base level	$2,500 annual maximum per member (Plan reimbursement is available after an initial 6 month waiting period)
Network of providers	No network, use any dentist
Coordination of benefits	Plan doesn’t coordinate benefits with other dental plans (If traditional dental insurance is active, dental insurance must be used prior to any reimbursements from the Denbrella program)

Services not covered:

Exams
Cleanings (preventative)
X-rays (bitewings; preventative)
Implants
Teeth whitening
Orthodontics (child and adult)

Services covered:

Fluoride (up to age 16)
Sealants
Space maintainers
Fillings
Simple extractions
X-rays (panoramic & medically necessary)
Oral surgery
Root canals (endodontics)
Gum disease treatment (periodontics)
Crowns
Bridges
Dentures

Select Payment Plan*

Monthly - $19/mo

Annually - $205/yr

Select Payment Plan*

Monthly - $39/mo

Annually - $420/yr

Select Payment Plan*

Monthly - $79/mo

Annually - $850/yr

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