Untitled Document

Dental Plan

1.	Product Highlights
2.	Standard Plan
3.	Executive Plan
4.	General Information
5.	Major Exclusions

Product Highlights

You may choose between 2 benefit levels - Standard Plan or Executive Plan.

Your coverage extends to treatments by any registered dentist of your own choice.

You can enjoy a worldwide coverage.

There is no entry age limit for the plan.

Standard Plan

The plan pays 80% of eligible expenses up to the following limits unless otherwise stated:

Benefits

Maximum Payable
(HK$)

1.	X-RAYS required prior to performance of dental service.

a. Single Film

Each

b. Each Additional Film

Each

ABSCESSES

a. Without Surgery

Each

300

b. With Surgery

Each

600

3.	AMALGAM FILLINGS Molar & Pre-molar

a. Per Filling -1 surface

Each

300

b. Each additional surface

Each

150

c. Maximum per tooth

Each

600

4.	PINS FOR CUSP RESTORATION

a. First Pin

Each

210

b. Subsequent pin for same tooth

Each

110

5.	ANTERIOR FILLINGS

a. Composite

Each

400

b. With acid etch

Each

650

6.	ROOT CANAL FILLINGS

a. One root

Each

1,500

b. Subsequent roots for same tooth

Each

700

7.	EXTRACTIONS

a. Uncomplicated

Each

400

b. Surgical, impacted wisdom teeth

Each

1,800

8.	APICOECTOMY

Anterior teeth

Each

1,800

9.	DENTURES - When required as a result of accident only

a. Both sets full upper & lower

7,000

b. One full set upper or lower

3,500

c. Partial sets

i. Preparation plate

3,500

ii. Each tooth

250

10.	ROUTINE ORAL EXAMINATION

Scale & Polish & Prophlaxis

100% Reimbursement (twice a year)

Each

400

* This benefit is subject to an Elimination Period of 365 days.

Maximum limit per year (excluding cost of dentures)

7,500

Executive Plan

The plan pays 100% of eligible expenses up to the following limits:

Benefits

Maximum Payable
(HK$)

Include all the benefits listed in the Standard Plan (except item 9)

11.	PERIODONTAL SURGERY

a. Subgingival curettage (per treatment)

Each

680

b. Gingivectomy (per quadrant including post surgical visits)

Each

1,500

c. Gingivectomy, treatment per tooth (fewer than six teeth)

Each

500

12.	APICOECTOMY - MOLAR & PRE-MOLAR

Each

2,200

13.	GOLD INLAY

a. One Surface

Each

1,850

b. Two Surfaces

Each

2,500

c. Three Surfaces

Each

3,200

14.	CROWNS & BRIDGES

a. Acrylic Jacket Crown

Each

1,700

b. Porcelain Jacket Crown

Each

2,500

c. Bridgework

Each

2,200

15.

DENTURES

When required as a result of accident or disease

a. Both sets full upper & lower

7,000

b. One full set upper or lower

3,500

c. Partial sets

i. Preparation plate (as a result of accident)

3,500

ii. Preparation plate (as a result of disease)

1,650

iii. Each tooth

250

16.	ACCIDENT EMERGENCY TREATMENT

Including X-rays, temporary pain relief, temporary fillings, medication, incision & drainage of abscess

500

Outside normal working hours

1,200

17.	PARTIAL SOFT-TISSUE IMPACTION

700

18.	COMPLETE SOFT-TISSUE IMPACTION

1,800

19.	BONY IMPACTION

1,100

20.	ORTHODONTIC TREATMENT

(necessitated by threat to the health of the Insured & recommended as necessary by qualified physician or dentist)

6,000

21.	PANORAMIC FILM

250

Maximum limit per year (excluding cost of dentures)

14,500

General Information

•	The policy shall become effective after the completion of the pre-insurance oral examination with a report issued by the examining dentist. (Waiver of pre-insurance oral examination applies to child aged under 4.)

•	The pre-insurance examination shall be performed by a dentist nominated by Blue Cross, but any subsequent treatments required may be obtained from any qualified dentist of your own choice.

•	Any dental abnormalities or conditions recorded at the time of pre-insurance examination shall be covered starting from the 13th month after the insured member has joined the plan.

Major Exclusions

This Policy does not cover:

1.	Any dental abnormalities or conditions recorded at the time of pre-insurance examination requiring treatment within the first 12 months of initial period of insurance.

2.	Self-inflicted disease or injury, alcoholism or drug addiction.

3.	Care or treatment for which payment is not required or which is payable by any other insurance.

4.	Racing(except foot-racing), motor-cycling, skydiving, scuba diving, mountain climbing, flying except as a fare-paying passenger on a duly licensed commercial aircraft .

5.	Deliberate exposure to exceptional danger except in an attempt to save human life.

6.	Any act of war, riot, strike or civil commotion.

Note: Above is for reference only. Please refer to the actual policy for exact terms and conditions.

The above product(s) is/are offered for sale in Hong Kong only and are underwritten by Blue Cross (Asia-Pacific) Insurance Limited, an authorised insurer in Hong Kong.