Fortis Dental Care

The Chamber of Commerce

The Choice Is Yours!

As a valued member of The Chamber of Commerce, we're proud to offer you a choice between two dental plans. This dental benefit program, provided by Fortis Benefits Insurance Company, consists of a dental managed care plan and an insured dental plan.

Managed Care

The Managed Care Plan, underwritten by DentiCare, Inc., provides a wide variety of benefits through participating dentists. You may change your dentist throughout-the plan year,* but all services must be performed by a participating provider. You will then be responsible for any copayments, which are reduced fees that you will pay directly to the dentist for some dental procedures. *as described in the Group Policy Provisions

Managed Care Features:

• No Deductibles No Claims to File No Annual Maximums No Waiting Periods

• Pre-Existing Conditions Covered

Indemnity Dental Plan

The Indemnity Plan, underwritten by Fortis Benefits Insurance Company, also provides a variety of benefits, but under this plan, you and your family may use any dentist or specialist. The indemnity plan pays a percentage of the Allowable Charge for those covered services described in your Group Certificate. Benefits are paid after any applicable deductible has been met up to the Annual Maximum. Allowable Charges are based on charges being made by providers in the area where the dental services are performed. Claim payments may be made to you or your dentist, whichever you prefer, unless benefits have been assigned to the provider.

Rates guaranteed until January 1, 2003

Indemnity Plan Features:

  • Freedom to Choose any Dentist, Including Specialists Nationwide Coverage
  • Fast and Accurate Claims Service
  • No Referrals Required

IMPORTANT:

Coverage for eligible members will begin January 1, 2002. You must sign up by the Initial Enrollment Deadline or forfeit the opportunity until the next policy anniversary date.
 


Savings You Can See

Monthly Payroll Deduction

Employee $29.88*
Employee + 1 $55.33*
Family $85.63*
* Add $2.00 per month administrative fee per employee/member.


ProThree
Underwritten by Fortis Benefits Insurance Company

Benefit Maximum, Per Person, Per Policy Year

$1000.00

     
Insured Percentage Allowable Charge Per Person, Per Policy Year  

 
Type I Type 11 Type III
During the 1st Year 100% 80% 10%
During the 2nd Year 100% 80% 25%
During the 3rd Year and thereafter 100% 80% 50%
     
Deductible, Per Person, Per Policy Year $50.00
This deductible applies to Type II and III Services only.
(Waived for Type I Services)


Type I Dental Services, Including:

  • Routine Oral Examinations - once every 12 months in a row
  • Routine Dental Cleanings - once every 6 months in a row (Frequencies combined with Periodontal Maintenance)
  • Fluoride Treatment - once every 12 months in a row Only for children under age 14
  • Sealants - once per permanent molar Only for children under age 16
  • Space Maintainer Only for children under age 16 (includes adjustments within 6 months of installation)
  • Harmful Habit Appliance - once per person Only for children under age 16
     

Type II Dental Services, Including:

X-Rays:

  • Complete series - once every 60 months
    • Bitewing - once every 12 months
    • Panoramic - (only considered with the removal of impacted teeth)
    • Other X-Rays (See Certificate of Insurance)
  • New Fillings; Replacement Fillings - once every 24 months per Filling
  • Simple Extractions, Removal of Exposed Roots, Incision and Drainage
  • Certain Lab Tests, Pain Treatment, Therapeutic Drug Injections


Type III Dental Services, Including:

  • Endodontics (includes root canal therapy)
  • Complex Oral Surgery; General Anesthesia and IV Sedation when medically required for such Surgery
  • Minor Gum Disease Treatment: (Minor Periodontics)
    • Provisional Splinting, Occlusal Adjustments - once every 12 months
    • Scaling and Root Planing - once every 24 months per area
    • Periodontal Maintenance - once every 6 months
    • (Frequencies combined with Routine Dental Cleanings)
  • Major Gum Disease Treatment: (Major Periodontics)
    • Gingivectomy, Osseous Surgery, other major periodontic procedures - once every 36 months per area
    • Initial Placement, Replacement and Maintenance of Inlays, Onlays, Crowns, Fixed Partial Dentures (Bridges), and Partial
      and Complete Dentures
       

    Other Policy Provisions

    Limitations and Exclusions
    No benefits arc payable for natural teeth missing on date of insurance, care that is not necessary, not listed under the Schedule of Dental Services in your Group Policy, not professionally endorsed; experimental or cosmetic in nature; care for which there is no legal obligation to pay, not incurred while insured; work-related-, TMJ disorders, orthodontics, implants, vertical dimension, bite registration; emergency oral exam; loss due to war, riot, felony, or assault.

    Benefit Adjustments
    Benefits will be coordinated with any other dental coverage. Under the Alternative Treatment provision, benefits will be payable for the most economical services or supplies meeting broadly accepted standards of dental care. If the cost of a proposed Dental Treatment Plan exceeds $300, it should be submitted to Fortis Benefits Insurance Company for an estimate of benefits payable.

    Eligibility
    Full-time member, spouse and unmarried dependent children.

    Late Entrants
    If you elect coverage more than 31 days after your Fortis DentalCare Eligibility Date, your Effective Date will be delayed to the next plan Anniversary Date.

    This is a brief description only It is not a Certificate of Coverage Please see the Group Policy w i a o determines all rights benefits, and applicable limitations and Exclusions.


    Monthly Payroll Deduction

    Employee $10.21 *
    Employee and One Dependent $17.27*
    Employee and Two or More Dependents $27.24*
    *Add $2 per month administrative fee per employee/member
    The following is a sample of some of the most frequently used dental treatments. When you enroll for coverage, treatments you receive from your Plan Dentist will be provided at reduced fees called copayments. (After you enroll, a complete list of copayments will be provided to you along with your Evidence of Coverage.)


    Pinnacle Plan
    Underwritten by DentiCare of Alabama, Inc.

    1. Plan Dentist Services
    The dental services fisted on this sample Copayment Schedule are covered only when provided by the Member's selected Plan Dentist. Members will be responsible for paying the amount listed in the "Member Copayment" column at the time the service is received, or in accordance with the Plan Dentist' s billing procedures.

    Except in the cam of covered dental emergency services, payment for all services received from a non-Plan Dentist will be the responsibility of the Member

    2. Plan Specialist Services
    Should Member require dental services that his selected Plan Dentist is unable to provide, he may obtain those services from a Plan Specialist at a discounted rate. No referral is needed from the selected Plan Dentist in order for Member to obtain services from Plan Specialist. There is no applicable copayment schedule for Plan Specialist services. Instead, the following discounts will apply. A 15% discount off that Plan Specialist's normal retail charges will be applied to charges obtained from a Plan Specialist who is an Endodontist. A 25% discount off that Plan Specialist's normal retail charges, will be applied to all other services (including orthodontic services) received from a Plan Specialist. Member will be responsible for paying the entire discounted charge at the time the service is received, or in accordance with the Plan Specialist's billing procedures.

    Except in the case (covered dental emergency services payment for all services received from a Plan or non-Plan Specialist be the responsibility of the Member.

    ADA Code Plan Dentist Treatment Member Copayment
      Appointments  
    999 Routine Office Visit 5.00
    120 Periodic Oral Evaluation  No Charge
    150 Comprehensive Oral Evaluation No Charge
    9999 Missed Appointment without 24-Hour Notice 20.00
      Diagnostic Dentistry  
    210 X-Ray - Intraoral, Comp. Series, Ind. Bitewings 5.00
    415 Bacterial Studies No Charge
      Preventive Dentistry  
    1110 Routine Prophy/Cleaning - Adult (once every 6 mos.) 5.00
    1120 Routine Prophy/Cleaning - Child (once every 6 mos.) 5.00
    1203 Topical Application of Fluoride - (Child) No Charge
    1330 Oral Hygiene Instruction No Charge
    1351 Application of Sealant, Per Tooth 8.00
    1510 Space Maintainer (Fixed) - Unilateral* 60.00
    1515 Space Maintainer (Fixed) - Bilateral* 70.00
    1520 Space Maintainer (Removable) - Unilateral* 60.00
    1525 Space Maintainer (Removable) - Bilateral* 80.00
      Restorative Dentistry (Fillings/Crowns)
    2110 Amalgam - One Surface, Primary 15.00
    2120 Amalgam - Two Surfaces, Primary 20.00
    2130 Amalgam - Three Surfaces, Primary 25.00
    2131 Amalgam - Four or More Surfaces, Primary 30.00
    2140 Amalgam - One Surface Permanent 15.00
    2150 Amalgam - Two Surfaces, Permanent 20.00
    2160 Amalgam - Three Surfaces, Permanent 25.00
    2161 Amalgam - Four or More Surfaces, Permanent 30.00
    2330 Resin Filling - One Surface, Anterior 20.00
    2331 Resin Filling - Two Surfaces, Anterior 30.00
    2332 Resin Filling - Three Surfaces, Anterior 35.00
    2335 Resin Filling - Four or More Surfaces, Anterior 40.00
    2385 Resin Filling - One Surface, Posterior, Permanent 30.00
    2386 Resin Filling - Two Surfaces, Posterior, Permanent 40.00
    2387 Resin Filling - Three or More Surfaces, Post., Perm 70.00
    2750 Crown - Porcelain Fused to High Noble Metal* 290.00
    2962 Labial Veneer (Porcelain Laminate) - Lab* 315.00
      Endodontics (Root Canals)  
    3310 Root Canal - Anterior (excluding final restoration) 105.00
    3320 Root Canal - Bicuspid (excluding final restoration) 145.00
    3330 Root Canal - Molar (excluding final restoration) 200.00
      Periodontics  
    4341 Periodontal Scaling and Root Planing, Per Quadrant 35.00
    4355 Full Mouth Debridement (Complicated Cleaning) 25.00
      Removable Prosthodontics (Dentures)
    5110 Complete Upper Denture* 400.00
    5120 Complete Lower Denture* 400.00
    5211  Partial Denture -Upper Resin Base* 350.00
    5212 Partial Denture - Lower Resin Base* 350.00
      Fixed Prosthodontics  
    6750 Crown Porcelain Fused to High Noble Metal, Per Unit* 290.00
      Oral Surgery  
    7110 Single Tooth Extraction 20.00
    7120 Each Additional Tooth Extraction, Per Visit 20.00
    7220 Removal of Impacted Tooth - Soft Tissue 40.00
    7230 Removal of Impacted Tooth - Partial Bony 60.00
    7240 Removal of Impacted Tooth - Complete Bony 70.00
    7241 Removal of Impacted Tooth - Complete Bony, with Complications 90.00
    *Members are responible for additional lab fees for these services

    This is a sample Member Copayment Schedule which does not list all Member benefits and copayments. It is not an Evidence of Coverage. Please see the Group Dental Service Agreement Evidence of Coverage and Copayment Schedule whih determine all rights, benefits, and applicable Limitations and Exclusions.

    Choosing a Dentist

    1. Select an available Family Dentist from this directory for each family member.
    2. List the dentist's name on your enrollment form along with the ID#. Dentists not available to new patients are indicated with an * in place of the ID#. If you are not currently a patient, you may not select these dentists.
    3. If you are unable to choose a dentist at the time of enrollment, you must call the Customer Service Department on or after your effective date of coverage and select a dentist before you can make an appointment.

    Changing Your Selected Dentist

    You may select another available Family Dentist by calling your Customer Service Hotline during normal business hours and requesting a change of dentist. (Request must be received by the 20th of the month to be effective the first day of the following month.) Updated directories of available dentists can also be obtained from your Customer Service Department.

    Referrals to Specialists
    No referrals are necessary.

    Missed Appointments
    You must give a 24 hour notice to your dentist's office, or you may be charged a missed appointment fee as listed in your Schedule of Benefits.

    This directory is subject to change. For updated information, contact Customer Service.

    Managed Dental Care
    Participating General Dentist Directory
      Alabama
    as of October 05, 2001
             
    City
    Provider/Dentist

    ID#

    Phone Address Zip Special Services
    Adamsville        
    Dunn, Thomas L DMD   (205)674-8200 4050 Adamsville Pkwy. 35005
    Alexander City        
    Brackett, Joni P DMD

    0005587

    (256)329-8401 1572 Mills Square 35010
    Lake Martin Family Dentistry        
    Tso, Raymond C DDS

    0011734

    (256)234-6011 659 Alex City Shopping Ctr 35010
    Vishnu, Bawani DMD

    0011734

    (256)234-6011 659 Alex City Shopping Ctr 35010
    Young, David C DMD

    0011734

    (256)234-6011 659 Alex City Shopping Ctr 35010
    Anniston        
    Beverley C Rodgers        
    Rodger, Beverly C DDS

    0012336

    (256)236-4626 1616 Cooper Ave 36201
    Arab        
    Willis, Catharine B DMD

    0005379

    (256)586-3117 1178 N Brindlee Mountain Pkwy 35016
    Auburn        
    Dr Botta        
    Botta. Nicholas E. DDS

    0012011

    (334)887-5086 227 Magnolia Ave 36831
    Bessemer        
    Cole, Paul T DDS

    0005426

    (205)428-5421 1931 Carolina Ave 35020
    Lewis, Jones P DDS

    0005399

    (205)426-6070 5227A Bessemer Super Hwy, Ste 950 35020  
    Williams, Leotis DMD

    0005584

    (205)424-0029 5227A Bessemer Super Hwy 35020
    Birmingham        
    Birmingham Eastern Family Dental Care        
    Jackson, Adolphus M DMD

    0012169

    (205)836-4044 524 Red Lane Rd, Ste F 35215 H/
    Peoples, Deveta C DDS

    0012169

    (205)836-4044 524 Red Lane Rd, Ste F 35215 H/
    Buckner & Walker PA        
    Buckner, Mark A DDS   (205)956-8977 3920 Kilgore Memorial Dr 35210
    Richesin, Robert Derek DMD   (205)956-8977 3920 Kilgore Memorial Dr 35210
    Walker, Thomas G DMD   (205)956-8977 3920 Kilgore Memorial Dr 35210
    Cahaba Family Dentistry PC        
    Deathrage, James R DMD   (205)822-9570 2409 Acton Rd, Ste 117 35243
    Gann, David W DMD   (205)822-9570 2409 Acton Rd, Ste 117 35243
    Clairmont Cosmetic & Family Dentistry        
    Pak, Stephen H DDS

    0011297

    (205)326-8060 716 32nd St S 35233  /B/
    Daniel, Joseph E DMD   (205)967-7750 3172 Cahaba Heights Rd 35243
    Dr Charles S Cauthen DDS        
    Cauthen, Charles S DDS

    0012028

    (205)833-1532 9617 Parkway E 35215 H/
    Dr Genesis Pittman DMD        
    Pittman, Genesis DMD

    0005402

    (205)780-7132 .1723 3rd Ave W 35208
    Gray, Booker T DMD

    0005422

    (205)322-5462 1520B 7Th Ave N 35203
    Greensprings Dental Services        
    Burl McWilliams, Shawn Y DDS

    0012054

    (205)943-8555 40 Green Springs Hwy 35219  H/
    Hamsberry, Elvin G DDS

    0012247

    (205)925-1116 1805 Bessemer Rd 35208 H/
    Howard Jr, Leon DDS

    0005409

    (205)925-4252 1730 Jefferson Ave SW 35211
    Howard, Robert M DDS

    0011613

    (205)322-2103 1630 4Th Ave N, Ste 102 35203
    Nelson, Thomas R DDS

    0005302

    (205)836-6111 7703 1 St Ave S 35206
    Powell 111, William D DMD

    0012156

    (205)823-0770 3021 Lorna Rd, Ste 307 35216
    Soloymani, Keyvan DMD

    0005403

    (205)322-5437 1520B 7Th Ave N 35203
    Spink, Carol B DMD

    0011819

    (205)933-8032 2660 1OTh Ave S 35205
    Swanson, Reginald DMD

    0005396

    (205)798-1697 100 Avenue W 35214
    Thomas, Walter C DMD   (205)853-0650 1516 Center Point Pkwy, Ste 101 35215
    Wallace, Martha Cochran DMD

    0005372

    (205)823-2258 2038 Patton Chapel Rd 35216
    Weissman, Jeffrey DDS   (205)967-8636 3150 Overton Rd 35223
    West Princeton Dental Clinic        
    Jackson, Adolphus M DMD

    0011986

    (205)788-2124 859 Lomb Ave Sw 35211 H/
    Wilson, Lisa G DMD   (205)995-8084 5502B Caldwell Mill Rd 35242
    Woods Jr, Eddie PMD

    0005429

    (205)251-0186 101 6th Ave S 35205
    Decatur          
    Awoniyi, Wilatra DDS

    0005483

    (256)353-0410 1852 Beltline Rd SW, Suite A 35601 /B/
    Demopolis          
    Bassett, Rosalyn P DIVID

    0005477

    (334)289-9978 901 S Cedar Street 36732  
    Fairfield          
    Wallace, Stephen L DMD

    0005583

    (205)781-4141 7070 Aronov Dr, Ste D104 35064  
    Gadsden          
    Day, Charles T DMD

    0005437

    (256)547-2901 1601 Forrest Ave 35901  
    Hoover          
    Domnanovich, Joan DMD

    0005424

    (205)822-5991 2108 Lynngate Dr 35216  
    Huntsville          
    Dentistry Unlimited          
    Kirkendall, Brenda J DDS

    0011379

    (256)536-8561 1200 Jordan Ln Nw, Ste 2 35816  
    Drs Pullen & Pullen DMD PC          
    Jeffress, Jennifer Louis DDS   (256)533-3735 805 Madison St 35801  
    Pullen, Mark DMD   (256)533-3735 805 Madison St 35801  
    Pullen, Joe DMD   (256)533-3735 805 Madison St 35801  
    McCray, Roy H DDS   (256)852-6954 2510 Pulaski Pike NW 35810  
    Moore, C Bryan DDS   (256)539-2020 1717 Pulaski Pike 35816  
    Scott Jr, Eugene H DDS   (256)533-0434 401 Lowell Dr, Ste 17 35801  
    Whitt, Blanca R DMD

    0005322

    (256)534-7267 2310 Whitesburg Dr S, Ste 5 35801  
    Laceys Spring          
    Willis, Catharine B DMD

    0005382

    (256)498-3570 601 Rockvale 35754  
    Madison          
    Horizons Dental Care          
    Ezell, Gail R DDS

    0005420

    (256)837-1200 7185 Highway 72 W, Ste C 35758  
    Williamson, Maria DDS

    0005420

    (256)837-1200 7185 Highway 72 W, Ste C 35758  
    Merldianville          
    Frazier, Ads DDS

    0005582

    (256)828-1500 11808 Highway 231/ 431 NE 35759  
    Mobile          
    Berger, Gerald DMD

    0005486

    (334)344-1255 5216 Overlook Rd 36618  
    Easley, Charles B DMD

    0012154

    (334)479-4574 2152 Airport Blvd 36606  
    Montgomery          
    Griffin, Johnny M DDS

    0011821

    (334)274-9861 1401 185 Pkwy, Ste D 36106  
    Hill, Kent D DDS

    0005430

    (334)613-0626 2920 Martin Ln 36116  
    Pleasant Grove          
    Robinson, Steven G DMD

    0012406

    (205)744-7021 717 Ist Ter 35127  
    Solomon, Jeffery J DMD

    0005332

    (205)781-5599 27 Park Rd, Bldg 900 35127  
    Prichard          
    Smith, Roy Lee DDS

    0011807

    (334)452-3991 107 Lovejoy Loop 36610  
    Russellville          
    Hammack, Steven D DMD

    0005462

    (256)332-6888 531 Saint Clair St SE 35653 /B/
    Selma          
    Hopson III, Iverson DDS

    0005376

    (334)874-4311 1415 Jeff Davis Ave 36703  
    Tuscaloosa          
    Clary, Rollins DMD

    0005454

    (205)758-6738 601 Hargrove Rd E, Ste A 35401  
    Griggs, Catherine M DMD   (206)345-1136 41 0B 15Th St E 35401  
    Union Springs          
    Williams, Letitia M DDS

    0005467

    (334)738-3111 301 N Prairie St 36089  /B/
    Warrior          
    Warrior Family Dentistry          
    Parvin, Scott A DMD

    0005469

    (205)631-4246 211 North Mail St 35180  
    Warrior Family Dentistry          
    Kim, David Y DDS

    0012142

    (205)647-3181 211 Main St N 35180  
    Wetumpka          
    Wetumpka Family Dentistry          
    Tso, Raymond C DDS 0011735 (334) 567-4334 4045 Hwy 231 36093  
    Vishnu, Bawant DMD 0011735 (334) 567-4334 4045 Hwy 231 36093  
    Young, David C DMD 0011735 (334) 567-4334 4045 Hwy 231 36093  
    Woodstock          
    Woodstock Family Dentsitry          
    Perdomo Watts, Miriam DMD 0012310 (205) 938-9727 20036 Highway 11 35168 H/
    * - Closed to New Patients

    H - Extended Office Hours

    B - Bilingual Assistance

     

    Endodontist

    Birmingham      
    Cissell, Darin V DMD (205)870-1064 1711 Independence Ct, Ste 3 35216
    Keith, Shandra L DMD (205)930-0705 2305 Arlington Ave 35205
    McCallum, Christopher DDS (205)824-0018 2531 Rocky Ridge Rd, Ste 122 35243
    Mobile      
    Thomas H Hannahan DMD      
    Hannahan, Patrick E DMD (334)342-1002 3602 Old Shell Rd 36608
    Hannahan, Richard P DMD (334)342-1002 3602 Old Shell Rd 36608
    Hannahan, Thomas H DMD (334)342-1002 3602 Old Shell Rd 36608
    Oral Surgeon
    Alexander City      
    Alabama Oral Surgery P.C.      
    Bailey, Warren K DMD (256)329-3050 3368 Highway 280 35010
    Birmingham      
    Alabama Oral Surgery      
    Bailey, Warren K DMD (205)252-1212 2114 1 0th Ave S 35205
    Bailey, Warren K DMD (205)930-0900 2114 1OTh Ave S 35205
    Carr, Dennis D DMD (205)991-9787 101 Heatherbrooke Rd 35242
    Gonzalez, Luis A DMD (205)991-9787 101 Heatherbrooke Rd 35242
    Matthews Jr, George W DMD (205)871-1520 2045 Brookwood Medical Ctr Dr, Ste 6 35209
    Michael Koslin DMD      
    Kahn, Christopher DMD (205)979-9738 2036 Patton Chapel Rd 35216
    Koslin, Michael DMD (205)979-9738 2036 Patton Chapel Rd 35216
    Szymela, Victor F DMD (205)250-6064 1528 N 26th St., 8th FIr 35234
    William P Buck Jr DMD      
    Buck Jr, William P DMD (205)933-1331 1112 19Th St S 35205
    McKay, Henry E DDS (205)933-1331 1112 19Th St S 35205
    Rothman, Christopher M DDS (205)933-1331 1112 19Th St S 35205
    Huntsville      
    Clark, Phyllis DDS (256)534-5028 2314 Pansy St SW 35801
    Sylacauaa      
    Alabama Oral Surgery P.C.      
    Bailey, Warren K DMD (256)245-1000 122 S Anniston Ave 35150
    Orthodontist
    Birmingham      
    Bloom, James P DDS (205)956-4277 2205 Cahaba Valley Dr, Ste 200 35242
    Farmer, Don L DMD (205)871-7081 482 Palisades Blvd 35209
    Forestdale      
    Bloom, James P DDS (205)991-6575 2129 Forestdale Blvd. 35214
    Gadsden      
    Bloom, James P DDS (800)336-6689 415 S 4Th St 35901
    Hoover      
    Birmingham Orthodontic Specialist      
    McCarthy, Michael F DMD (205)733-2022 3825 Lorna Rd, Ste 248 35244
    Huntsville      
    Lawson, Thomas C DMD (256)539-9553 2310 Whitesburg Dr S, Ste 4 35801
    Yarbrough, David E DDS (256)837-2200 4925 University Dr NW 35816
    Springville      
    Farmer, Don L DMD (205)871-7081 420 Walker Drive 35146

    Downloads:

    Dental Agreement

    Dental Group Enrollment