dentalbydesign

A COMPLETE DENTAL INSURANCE PORTFOLIO FROM COMPANION LIFE.

dentalbydes
Considering dental insurance for

groups with 10 or more employees?

What features and benefits

are important to you?

Companion Life recognizes that dental
by group, industry and region. Employers
insurance needs can vary
are looking for benefit programs
that are unique and flexible. We took a close look at these dental insurance needs
and went “to the drawing board” to create exceptional and practical Group Dental
Insurance plans for employer groups of 10 or more.
flexible options.
You asked for affordable, progressive dental insurance solutions. We listened.
versatile plan designs. Your objectives and your needs are our inspiration. Dental by Design SM plans are
reasonable premiums. developed with maximum flexibility in mind — for you and your employee groups!

Have it all with Companion Life!

tailor our plan to your needs

Realize the power of distinct design with unique and exceptional plan flexibility
from Companion Life.

We’re confident that you’ll find a plan that suits your needs! How can we be so sure?
You may customize any of our standard Dental by Design benefit plans — Dental
Essentials, Dental Choice or Dental Select — to include the options that are just
right for your group.

A wide choice of options is available to modify these program features. Options like
deductible, number of deductibles per family, incentive plan, waiting
periods, contract year maximum, increasing maximum, orthodontia
benefits (adult available), exams and X-rays, frequency of cleanings,
rate structure (standard is four), and retiree dental benefits.

Custom programs from Companion Life … it’s easy to create a unique plan with
the Companion Life Dental by Design portfolio. Select the benefit design that
works for you, then choose your option(s) on our convenient Request for Proposal
(RFP) form.
 Your group has selected the Dental Choice plan, but would prefer to have cleanings

sign
covered only once a year with coinsurance options of 80/80/50. Simply check the
appropriate benefit options on your RFP form. Our Underwriting staff will provide
a proposal for your custom-made Dental by Design plan.

e x ample

inno v ati v e dental insurance solutions

Take a look at our plans! First select the standard benefit plan that best meets your needs.
Dental Essentials, Dental Choice and Dental Select provide a choice of effective benefit solutions
to fit any budget.

standard benefit designs

services dental essentials dental choice dental select
Program Deductible
Per Individual $100 Lifetime $100 Lifetime $100 Lifetime
Family Limit No Limit No Limit No Limit
Waived for Type I Services? No No No

Type I 100% 100% 100%
Preventive Services oral exams, cleanings (two per oral exams, cleanings (two per oral exams, cleanings (two per
12 months), bitewing X-rays 12 months), bitewing X-rays 12 months), bitewing, X-rays
(one per 12 months) (one per 12 months), (one per 12 months),
space maintainers, pain treatment, space maintainers, pain treatment,
sealants sealants, full mouth X-rays

Type II 80% 80% 80%

Basic Services space maintainers, fillings, pain full mouth X-rays, fillings, fillings, anesthesia, endodontics,
treatment, sealants, full mouth X-rays simple extractions, endodontics simple and surgical extractions,
oral surgery, periodontics
Benefit Waiting Period None None None

Type III 50% 50% 50%

Major Services anesthesia, endodontics, anesthesia, surgical extractions, crowns, inlays, onlays,
simple and surgical extractions, oral surgery, periodontics, crowns, inlays dentures, bridges, implants
oral surgery, periodontics, crowns, inlays onlays, dentures, bridges, implants
onlays, dentures, bridges, implants
Benefit Waiting Period 12 months 12 months 12 months

Contract Year Maximum $1,000 $1,000 $1,000

Type IV Orthodontia (Optional) 50% 50% 50%

Lifetime Maximum $1,000 $1,000 $1,000
Deductible None None None
Benefit Waiting Period 12 months 12 months 12 months

Payment is based upon allowable charges in the area in which the service is rendered.
 Companion Life Insurance Company has specialized in group benefits for more
than 30 years. We have earned A.M. Best’s rating of A+ (Superior) due to our
fiscal strength, investment practices and sound operational and management
structure. At Companion Life we are committed to financial strength, effective
corporate management and the highest level of service and responsiveness to our
clients and sales associates.

C ompanion life

Here’s what you need

for a Companion Life
Freedom of Choice
Dental by Design proposal:
What does freedom of choice mean to you? You can use your own dentist! There
are no network restrictions of any kind with Companion Life Dental Insurance plans.
Group Name
What are the advantages of having a dental program? An enhanced employee
State and ZIP Code
benefit program; Improved employee health and attendance; A boost in employee morale;
Nature of Business or SIC Code A competitive edge when recruiting and retaining talented employees. Furthermore, the
Proposed Effective Date Surgeon General’s 2002 report on Our Health for America notes that cost is the major
Current and Renewal Rates for impediment to obtaining adequate dental care. Fifty-six percent of employees without
Inforce Dental Coverage (if any) dental insurance rank it, after medical coverage, as the most-desired employee benefit.
Selected Benefit Design What are the employer contribution and employee participation require-
Dental Essentials, ments? For employer contribution plans, a minimum of 25 percent employer contribu-
Dental Choice or tion and 50 percent employee participation is required. There is no dependent participa-
Dental Select
tion requirement. For 100 percent employee paid plans, either 20 percent employee
Benefit Options Requested (if any) participation or three employees must participate, whichever is greater.
for a Custom-Designed Plan
Can I use my own dentist? Yes! With all Companion Life dental plans you have
Premium and Claim Experience for
Employer Groups of 100 or More
freedom of choice to visit any dentist.
How can I, or my dentist, check my claim’s status? Use our secure online tool,
Or, you can complete the My Insurance CompanionSM! Go to www.CompanionLife.com and click on Members
convenient Companion Life
from the home page. Dentists can click on Providers. Check claim status, request an ID
Request for Proposal (RFP) form,
which details the available options. card, ask Customer Service, and more! Or, use our voice activated response system.
These services are available seven days a week. Or, simply call 1-800-765-9603.
Companion Life’s Dental How are claims filed? Your dentist’s office can file your claim for you. Companion Life
Insurance Portfolio also includes: will accept your dentist’s claim form by mail or fax. Your dentist can file claims online at
Dental “Cents” for groups www.CompanionLife.com with My Insurance Companion.
of 2–9 employees
Voluntary dental plans for groups
with as few as three employees takeover benefits
Takeover means that we give employees credit for waiting periods they have accumulated
For more information
for similar coverages under your current group dental plan.
or a proposal please contact:
Standard Takeover – An employee’s waiting period will be reduced by the amount
Companion Life
Insurance Company of time he or she was insured under your prior group dental plan. The prior dental plan
P.O. Box 100102 must have been in effect continuously for at least 12 months prior to the effective date of
Columbia, SC 29202-3102 this plan. All waiting periods will apply to future new employees.
www.CompanionLife.com Preferred Takeover – The waiting period(s) for existing employees including those who
Or call Group Marketing weren’t on the prior plan will be waived. The prior dental plan must have been in effect
at 800-753-0404 continuously for at least 12 months prior to the effective date of this plan. All waiting
800-836-5433 (Fax) periods will apply to future new employees.
Incentive Plan Takeover – If this group dental policy replaced the employer’s prior
group incentive dental insurance policy, and takeover benefits have been approved by
Companion Life, all employees insured under the prior plan are eligible for appropriate
credit for time served under the prior dental policy. The prior dental plan must have been
in effect continuously for at least 12 months prior to the effective date of this plan. All
waiting periods will apply to future new employees.

95177 Rev. 5/10

 Your dental by design Proposal

Thank you for reviewing this information about the dental by design portfolio from Companion Life. This
program of employer-funded Dental plans offers real flexibility and great sales potential and we want to make sure
that we clearly communicate how this unique portfolio works.

Every time you request a dental by design proposal, you will receive rates for the three Standard Benefit
Designs — Dental Essentials, Dental Choice, and Dental Select — based on your prospect’s demographics. Your
Request For Proposal (RFP) form shows the numerous Design Options available for each of these standard plans. If
you don’t select any Design Options, your proposal will show rates and benefits for only the three standard plans.
If you do select some of the Design Options available for one of the standard plans, your requested plan design will
appear as the “Requested Design” on the proposal.

The proposal also includes complete information about our new Takeover Provisions and clear definitions for dental
services and procedures.

We hope you’ll agree that your dental by design portfolio is “tailor made” to meet your marketing needs.
Please call for more information — or a proposal — today!

Group Marketing
(800) 753-0404
(800) 836-5433 (Fax)

95213 Rev. 5/10

 dental by design
Important Information

freedom of choice
This Dental program from Companion Life provides total access to any dentist, giving your employee the freedom to choose a provider
and needed services. Benefit payment allowances vary, depending on the area in which the services are rendered.
plan design
Dental by Design offers three basic benefit design platforms from which to choose. A wide range of program alternatives is available to
build a benefit package to meet the individual needs of any employer group. Choose from a large selection of options for deductibles,
waiting periods, benefit maximums, coinsurance, takeover benefits and much more.

takeover provisions for dental benefits

Standard Takeover – An employee’s waiting period will be reduced by the amount of time they were insured under your prior group
dental plan. The prior dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. All
waiting periods will apply to future new employees.

Preferred Takeover – The waiting period(s) for existing employees including those who weren’t on the prior plan will be waived. The
prior dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. All waiting periods
will apply to future new employees.

Incentive Plan Takeover – If this group dental policy replaced the employer’s prior group incentive dental insurance policy, and
takeover benefits have been approved by Companion Life, all employees insured under the prior plan are eligible for appropriate credit
for time served under the prior dental policy. The prior dental plan must have been in effect continuously for at least 12 months prior to
the effective date of this plan. All waiting periods will apply to future new employees.

definitions
Endodontics – The treatment of pathological conditions within the pulp chamber of a tooth or involving the root of a tooth; includes
root canal procedures.
Oral Surgery – Operative procedures performed in and about the oral cavity and jaws that are not performed in connection with
periodontic and endodontic surgical procedures.
Periodontics – The treatment of diseases of the tissues surrounding and supporting the tooth. It includes the gingiva (gum tissue),
cementum, alveolar (supporting) bone, root planing and periodontal cleaning.
Preventive Services – Oral examinations and cleanings are covered.
Simple Extraction – Uncomplicated removal of a tooth; not a cutting procedure.
Surgical Extraction – Removal of a tooth by means of surgical methods, usually involving the turning of a gingival flap or removal
of bone.
X-rays – One full mouth or Panorex X-ray will be allowed in any 36-month period. One series of bitewing x-rays will be allowed in a
twelve-month period under the standard plan designs.
Covered Implant Services – Available to adults and dependent children age 17 and older. Implant services include the accompanying
crown and are incurred on final placement of the prosthetic.
Dependents – Eligible dependents include the insured employee’s spouse and children prior to their 26th birthday who do not work for
the firm.
Companion Life Insurance Company / 7909 Parklane Road / Suite 200 / Columbia, South Carolina 29223
(800) 753-0404 / (803) 735-1251 / c.life@companiongroup.com / www.CompanionLife.com
 REQUEST FOR PROPOSAL (RFP )
shaded areas must be completed
Companion Life Insurance Company • P.O. Box 100102 • Columbia, South Carolina 29202-3102 1-800-753-0404 FAX (803)735-0736

Date Date Please complete all sections applicable to the coverages for which you are requesting a proposal.
Needed Complete the other side, or attach census data to this RFP.
Producer’s Name as
Group to Appear on Proposal
Name
Agency Name
City ST Zip
Address
Nature of
Business or SIC Code City State Zip
# of Employees Phone Number: ( )
Requested Effective Date: / / M Fax Rates to: ( ) Attn:
Current E-mail Address:
Carrier(s)
Comments or Special Requests:
M LIFE AD&D M STD M LTD
h Flat Amount h Flat Amount h PERCENT OF EARNINGS
vision M Yes M No $ on all $ / week on all % of Earnings
BASIC Full–time Employees Full–time Employees to $ max
COMMISSION: M STANDARD % FLAT MM h Multiple of Earnings h Percent of Earnings monthly benefit on all Full-time
Employees
x Earnings % of Earnings
OVERRIDE: M STANDARD % FLAT MM on all Employees to max
of $
to a max benefit of
$ /week
(STANDARD)

CLASS DESCRIPTION – employees in the classes below

are to be quoted for the benefits listed at right. h CLASS PLAN h CLASS PLAN h CLASS PLAN
(List benefits below.) (List benefits below.) (List benefits below.)

Employer Contribution % % %
Current Rate Per $1,000 Per $10 Per $100
Renewal Rate Per $1,000 Per $10 Per $100
LIFE REDUCTIONS ELIMINATION PERIOD
DENTAL SHORT TERM
M 35% at 65, Terminate DISABILITY M 90 Days M 180 Days
h DENTAL “CENTS” (2 to 9)
at 70 or Retirement
Percent of Premium Paid By Employer: M 120 Days M Other
(Groups of 2 to 9)
M Single/Employee Only ________________% (25% required) day(s) accident Benefit Integration
M Family/Employee & Dependents _______________% M 35% at 65, 50% at 70,
M PLAN A (100/80/50) $1,000 Max., $100 lifetime deductible M Primary and Family
75% at 75. Terminate at days sickness
(Standard)
M PLAN B (100/80/50) $1,000 Max, $25 and $50 contract year deductibles Retirement (Groups of 10 +)
M PLAN C (100) $1,000, $15 Copay Plan weeks M Primary Only
M PLAN D (100/80/50) $1,000 Max, $50 contract year deductible M Other
Benefit Duration
M TAKEOVER – PRIOR PLAN
M ORTHODONTIA (available for plan A, Plan B and Plan D only) h To Age 65 RBD
Extended Death Benefit h 5 Year h 2 Year
ORTHODONTIA TAKEOVER M Yes M No
(2-9 Employees)
h DENTAL By design (10 +) Own OCC Definition
Waiver of Premium
(See reverse for plan design availability and to request a Dental Plan.) (10+ Employees) M 2 Yr. M 3 Yr. M 5 Yr.
CURRENT RATES RENEWAL RATES M To 65
M Dependent Life Amount
Employee $ Employee $ Spouse $
E + Sp $ E + Sp $ Child(ren) $
M STD Claims Experience M LTD Claims Experience
E + Ch $ E + Ch $ M Life Claims Experience Attached (Groups of 100 +) Attached (Groups of 200+)
Family $ Family $ Attached (Groups of 150 +)
Percent of Premium Paid By Employer:
M Single/Employee Only ________________%
M FamilyEmployee & Dependents _______________% voluntary? voluntary? voluntary?
Is this Takeover Coverage? h Yes h No M Yes M Yes M Yes
If Yes, total years with Current Carrier
M Claims Experience Attached (Required for Groups of 100+) M No M No M No

95113 (Rev. 5/10)

 standard benefit designs
For Groups of 10 or More
Services M Dental Essentials M Dental Choice M Dental Select
Program Deductible
Per Individual $100 Lifetime $100 Lifetime $100 Lifetime
Family Limit No Limit No Limit No Limit
Waived for Type I Service? No No No
Type I – Preventive Services 100% 100% 100%
oral exams, cleanings (2 per 12 oral exams, cleanings (2 per 12 oral exams, cleanings (2 per 12
months), bitewing X-rays months), bitewing X-rays months), bitewing X-rays (1 per
(1 per 12 months) (1 per 12 months), space 12 months), space maintainers, pain
maintainers, pain treatment, sealants treatment sealants, full mouth X-rays
Type II – Basic Services 80% 80% 80%
space maintainers, fillings, full mouth X-rays, fillings, fillings, anesthesia,
pain treatment, sealants, simple extractions, simple & surgical extractions,
full mouth X-rays endodontics endodontics, oral surgery, periodontics
(Waiting Period) None None None
Type III – Major Services 50% 50% 50%
anesthesia, endodontics, simple & anesthesia, surgical extractions, crowns, inlays, onlays,
surgical extractions, oral surgery, oral surgery, periodontics, crowns, dentures, bridges,
periodontics, crowns, inlays, inlays, onlays, dentures, bridges, implants
onlays, dentures, bridges, implants implants
(Waiting Period) 12 months 12 months 12 months
Contract Year Maximum $1,000 $1000 $1000
Type IV – Orthodontia 50% 50% 50%
$1,000 Lifetime Maximum M Yes M No M Yes M No M Yes M No
Deductible None None None
(Waiting Period) 12 months 12 months 12 months
Takeover Benefit Preferred Preferred Preferred
M no design options – Issue Standard Benefit Design (above)
– OR –

Choose Design Options (if any) (below) Dental Essentials Dental Choice Dental Select
Incentive Plan - Percentage Increases in 2nd and 3rd M Yes M No M Yes M No M Yes M No
years; No Waiting Periods Apply; Incentive Plan 1st yr./2nd yr./3rd yr. 1st yr./2nd yr./3rd yr. 1st yr./2nd yr./3rd yr.
Takeover Only; If Selected, Child Orthodontia Type I-80%/100%/100% Type I-80%/100%/100% Type I-80%/100%/100%
Max is $375 annually and $1,000 Lifetime. Type II-50%/65%/80% Type II-50%/65%/80% Type II-50%/65%/80%
Type III-25%/35%/50% Type III-25%/35%/50% Type III-25%/35%/50%
Type IV-25%/35%/50% Type IV-25%/35%/50% Type IV-25%/35%/50%
Contract Year Deductible per Individual M $25 M $50 M $100 M $25 M $50 M $75 M $100 M $25 M $50 M $75 M $100
Limit Per Family M 3 M No Limit M 2 M 3 M No Limit M 2 M 3 M No Limit
Waive Deductible for Type I Services? M Yes M No M Yes M No M Yes M No
(N/A for Lifetime Deductible)
Frequency of Cleanings / Exams M 1 per 12 months M 1 per 12 months M 1 per 12 months
Frequency of Bitewing X-Rays M 2 per 12 months M 2 per 12 months M 2 per 12 months
Change the Contract Year Maximum M $500 M $750 M $1,200 M $500 M $750 M $1,200 M $500 M $750 M $1,200
M $1,500 M $2,000 M $1,500 M $2,000 M $1,500 M $2,000
Add Retiree Dental Benefit M Yes M No M Yes M No M Yes M No
Change the Premium Rate Structure M Two Tiers M Two Tiers M Two Tiers
(Standard is Four Tiers) M Three Tiers M Three Tiers M Three Tiers

the following design options are not available with the incentive plan
Change Coinsurance M 100/50/50 M 80/80/50 M 100/50/50 M 80/80/50 M 100/50/50 M 80/80/50
Add a Type II Waiting Period M 6 months M 12 months M 6 months M 12 months M 6 months M 12 months
Six Month Wait for Fillings Only M Yes M Yes M Yes
M No Waiting Period M No Waiting Period M No Waiting Period
Change the Type III Waiting Period M 6 months M 6 months M 6 months
M 24 months M 24 months M 24 months
Increase the Contract Maximum by $250 per Year M Yes M No M Yes M No M Yes M No
Maximum Cap after Increases $2,500/yr. M 2 Increases M 3 Increases M 2 Increases M 3 Increases M 2 Increases M 3 Increases
Change the Orthodontia Option
Orthodontia Lifetime Maximum M $750 M $1,500 M $2,000 M $750 M $1,500 M $2,000 M $750 M $1,500 M $2,000
Orthodontia Waiting Period M 24 months M None M 24 months M None M 24 months M None
Adult Orthodontia M Yes M No M Yes M No M Yes M No
Takeover Option M Standard Takeover M Standard Takeover M Standard Takeover

Your proposal will always include rates for the three Standard Benefit Designs. If no options are requested, please check the box “Propose Standard Benefit Designs – No Options.” To request
a Custom Benefit Plan, select one of the three Standard plans and select any changes to the Standard Benefit Design from the “Available Design Options” for that Plan.
limitations:
dental by design
I. covered expenses will not include, and no benefits will be payable:
1. For Class III and Class IV Procedures in the first 12 months that a person is insured, except as may be provided in the Takeover Benefits provision.
This exclusion does not apply to Incentive Plans.
2. For any treatment which is for cosmetic purposes, or to correct congenital malformations other than medically necessary treatment of con-
genital cleft in the lip or palate, or both.
3. To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of
these items. Replacement of an existing implant supported prosthetic device is covered only once every ten (10) years from the placement
date of such device and only then if it is unserviceable and cannot be made serviceable. However, if a replacement is required because of an
accidental bodily injury sustained while the Insured is covered under this policy it will be a covered expense.
4. For initial placement of any prosthetic appliance, implant or fixed bridge unless such placement is needed because of the extraction of one
or more natural teeth while the Insured is covered under this policy. The extraction of a third molar (wisdom tooth) will not qualify under
the above. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth.
5. For any procedure begun before coverage begins or after the Insured’s coverage terminates; or for any prosthetic dental appliances installed
or delivered more than 90 days after the Insured’s coverage terminates.
6. To replace lost or stolen appliances.
7. For appliances, restorations or procedures to:
a. alter vertical dimension
b. restore or maintain occlusion
c. splint or replace tooth structure lost as a result of abrasion or attrition
d. treat disturbances of the temporomandibular joint
8. Charges for a missed appointment, consultations or for completion of claim forms.
9. If applicable, orthodontia covered charges will not include charges for services:
a. payable under any other provisions or policy
b. rendered in the first 12 months the insured person is covered under the policy
c. incurred by employee or spouse, or incurred by dependent children after reaching the age of 19 (unless adult and child(ren) orthodon-
tia option is selected)
10. For sealants which are:
a. not applied to a permanent molar
b. applied after attaining age 16
c. reapplied to a molar within three years from the date of a previous sealant application
11. For application of fluoride after attaining age 19.
12. Because of an injury arising out of, or in the course of, work for wage or profit or eligible for benefits under Worker’s Compensation.
13. For services which are not recommended by a dentist or which are not required for necessary care and treatment.
14. For services related to equilibration, bite registration or bite analysis.
15. Crowns for the purpose of periodontal splinting.
16. Charges for any precision or semi-precision attachments, and any endodontic treatment associated with it, or other customized attachments.
17. For procedures not identified on the List of Dental Procedures in the Master Policy.
18. No benefit will be provided for implants or implant services where loss of the tooth was prior to the Insured’s effective date of coverage
under this dental plan.

II. payment for services shall be limited as follows:

If this plan replaces another plan of similar benefits and as a result offers takeover benefits, we limit what we pay to the lesser of: (a) what the prior plan
would have paid, or (b) what this plan would usually pay. We will deduct any benefits actually paid by the prior plan under any extension provision.

Companion Life Insurance Company / 7909 Parklane Road / Suite 200 / Columbia, South Carolina 29223
(800) 753-0404 / (803) 735-1251 / c.life@companiongroup.com / www.CompanionLife.com
95413 Rev. 8/09
 retiree dental/vision
P.O. Box 100102 • Columbia, SC 29202-3102
election Form
1-800-753-0404 • Fax (803) 735-0736

First Name Middle Initial Last Name

I am age 55 or older, I am retiring and I am currently enrolled in Companion Life’s dental plan through
my employer. I wish to continue my Companion Life:

M Dental Benefits

M Dental and Vision Benefits

For:

M myself only

M myself and my currently covered dependent(s).

I understand that I will be billed at home and that an extra $5.00 monthly administrative fee will be
added to my premium.

Signed: Date:

Required to be Completed by Employer:

As the group administrator for (group name)

(group number) , I certify that the above employee has
voluntarily terminated his/her employment with our company on (retirement date)
and is eligible to continue dental/vision benefits as a retiree for as long as our policy is in effect with
Companion Life.

95403 8/09
introducing extensive provider network
companion life’s Unlike other programs that may restrict provider options, Companion
vision discount plan Life’s Vision Discount Plan offers a nationwide network of convenient,
What is Companion Life’s Vision accessible options for eye care. Companion Life, in association with

Discount Plan? It’s a vision care EyeMed Vision Care, offers easy access to thousands of conveniently
located vision care providers including optometrists, ophthalmologists,
program combining unlimited
opticians and many leading optical retailers, such as LensCrafters®,
choice with quality and value.
Target Optical®, Sears Optical®, JCPenney Optical® and Pearle Vision®
And it is provided free of charge
locations.
to all employees and dependents access to more than 35,000 vision care providers
n
enrolled in any Companion Life at 18,000 convenient locations nationwide
dental plan. The provider network n evening and weekend hours at many locations
and customer service is by EyeMed n choice of thousands of fashionable, designer frames
Vision Care. n no appointment necessary, and service
in “about an hour” at most locations
www.eyemedvisioncare.com

quality Vision Care

EyeMed has a firm commitment to quality and patient satisfaction. All
EyeMed Vision Care providers must meet NCQA credentialing standards.
Providers are monitored through EyeMed’s Quality Assurance Program
and recredentialing process.

quality products
Companion Life’s Vision Discount Plan members have unlimited choice
of available eyewear products. Our members are free to select from any
available frame, including designer frames by Luxottica, such as Vogue,
®

Brooks Brothers, Anne Klein, and many more.

® ®

superior value
Members enjoy savings of up to 40% off retail prices at an unlimited
frequency.

service excellence
EyeMed focuses on delivering service excellence throughout all areas
of program administration, featuring call center representatives avail-
able seven days a week, including evenings. They combine innovative
solutions with the most current technology to enhance the administrative
experience for both clients and members.
companion life’s vision discount plan After initial purchase,
The Vision Discount Plan is included free of charge on any Companion Life replacement contact lenses
dental plan. may be obtained via the
Internet at substantial savings
Vision Care Services In Network Only
and mailed directly to the
Exam with Dilation as Necessary $5 off comprehensive exam
Contact Lens Follow-up Additional $5 off contact lens exam member. Details are available at
www.eyemedvisioncare.com.
When a complete pair of glasses is purchased (frame, lenses and lens Members will receive a 20%
options purchased in the same transaction), the following discounts apply.* discount on items not included
under plan coverage if purchased
Frames
at participating providers. This
Any available frame at provider location
20% discount may not be com-
35% off retail price when complete pair of eyeglasses purchased;
otherwise 20% discount. bined with any other discounts
or promotional offers, and does
Standard Plastic Lenses Member Pays not apply to EyeMed Provider’s
Single Vision $50 professional services or contact
Bifocal $70 lenses. Retail prices may vary
Trifocal $105
by location. Limitations and
exclusions apply.
Lens Options Member Pays
UV Coating $15 Contract Term: Discount valid
Tint (Solid and Gradient) $15 for 24 months from your group’s
Standard Scratch Resistant Coating $15 effective date.
Standard Polycarbonate $40
Standard Anti-Reflective Coating $45
Standard Progressive (Add-on to Bifocal) $65
Other Add-Ons and Services 20% off retail

Contact Lens Materials (Discount applied to materials only)
Conventional 15% off retail price
Disposable No discount

Laser Vision Correction**

Lasik or PRK
15% off retail price or 5% off promotional price

Frequency
Examination Unlimited
Frame Unlimited
Lenses or Contact Lenses Unlimited

this is not insurance.

* Items purchased separately will be discounted 20% off of the retail price.
**Since Lasik or PRK vision correction is an elective procedure, performed by specially
trained providers, this discount may not always be available from a provider in your
immediate location. For a location nearest you and the discount authorization, please call
1-877-5LASER6.

95311 Rev. 6/10

what is companion life’s hearing services plan? what does the plan do for you?
It’s a hearing care program combining unlimited choice The Companion Life Hearing Services Plan identifies
with quality and value. And it is provided free of charge and screens qualified experts — physicians and
to all employees enrolled in any Companion Life dental audiologists in your neighborhood. We also research
plan. The Hearing Services Plan (HSP) may be extended and evaluate hearing aid technolo-
to any family member! gy to assure that the

Hearing allows us to experience our world. Music, latest and most

radio, television, movies and theater are less accessible effective

and enjoyable without it. And the loss of sounds like options

sirens and alarms can actually endanger our lives.

why have a hearing services plan?

Ten percent of the U.S. population have some form
of hearing impairment. And hearing loss is the
number three chronic health problem in the country.
It is usually treatable, but fewer than 25% of people
who can benefit are treated, often because of concerns
about cost, difficulty in finding a hearing health
specialist or confusion about the wide range of
options in hearing aid technology.

With the Companion Life Hearing Services Plan, you

can get assistance, protection and treatment for your
hearing. Brought to you by Companion Life and EPIC
Hearing Health Care, this plan gives you easy access
to a national network of thousands of hearing health
are available to
professionals — primarily physicians and audiologists
you. We negotiate the
— who can help you achieve your maximum hearing
best prices for all treatments,
potential throughout your life.
including hearing aids. Prices you get from EPIC may be
The plan is a negotiated benefit. You pay nothing to join as much as 50% below manufacturers’ suggested retail
and get reduced rates for most fees and costs associated price and up to 35% lower than most discount offers.
with your hearing healthcare under the plan. And we also coordinate the coverage with your existing
healthcare plans.
how does someone know when to call? Then you will follow through with an appointment,

Hearing loss usually occurs gradually, without pain, examination and treatment. All payments should be

discomfort or deformity, but indicators like these should made to EPIC HSP. No other billing or payments should

prompt an evaluation: occur. And you can contact EPIC at any time for assis-
tance, advice and information.
Difficulty understanding voices and words
(especially those of women and children)
Occasional ringing in one or both ears summary of benefits and savings
Itching in the ear canals The Companion Life Hearing Services Plan benefits
Difficulty understanding in noisy situations and savings are:
Turning the TV volume up to understand the dialogue Hearing tests
In addition, more serious symptoms merit immediate Hearing aids
attention of a physician: Hearing aid batteries
Sudden hearing loss Ear protection
Spinning or dizziness with vomiting Swim plugs
Persistent ringing in one ear Musician earplugs
Blood or fluid draining from one or both ears Hearing aid cleaning supplies and accessories
Persistent pain in one or both ears Assistive listening devices
TV ears (amplifies and clarifies television)
getting started is easy! Alerting and signaling devices

To activate your Companion Life Hearing Services Plan To receive more information about the Companion Life
benefits, call EPIC Hearing Health Care at 1-866-956-5400. Hearing Services Plan, visit www.epichearing.com,
EPIC will send you a card with all the information you e-mail epic-admin@epichearing.com or call Customer
need to access your benefits, including Service at 1-866-956-5400.
referrals to providers near you
and activation forms to access about the epic organization
them. You get a booklet EPIC (Ear Professionals International Corporation)
outlining all the plan is the nation’s largest coalition of hearing healthcare
benefits, including physicians and audiologists. EPIC physicians pioneered
detailed pricing. And and developed many of the current treatments and
you get a personal EPIC are recognized nationally as leaders in professional
phone contact who can education, hearing diagnostics and interventions.
answer any questions you
may have.

95318 Rev. 6/10

companionglobaldental
A MONEY-SAVING ADVANTAGE THAT EVERYONE CAN SMILE ABOUT!

What is Companion Global Dental?

Companion Global Dental is an affordable choice for dental care. It offers
additional dental care options to patients at international medical facilities
and works with agents, employers, individuals and third party administrators.

With skyrocketing costs for dental procedures, people are discovering the
advantages of traveling outside the U.S. for dental procedures. Patients can
enjoy significant savings, and Companion Global Dental makes the process
easy and comfortable by providing help with all travel plans — even arranging
for tourism opportunities so patients can enjoy their surroundings in between
dental appointments.

Companion Life is the first national dental insurer to offer Companion Global
Dental as an added-value service to its dental plans at no additional cost.

Why travel for dental care?

Most of the reasons you need dental care
are not emergencies. This includes basic
restorative dentistry like crowns,
implants, bridges and other
procedures. Because they are
not emergencies, it means
you have time to plan
and choose a dentist.
Companion Global
Dental now gives you
another option to
consider — dental
tourism in Costa Rica.
You can now take
care of your smile
without breaking
your budget.

www.CompanionGlobalDental.com
Companion Global Dental gives There are many benefits of dental tourism!
you a money-saving alternative for Quality care You shouldn’t have to sacrifice quality for savings. You can enjoy
dental care, and a chance to enjoy both with the Companion Global Dental network of dental facilities in Costa
a tropical vacation with experts Rica. All the dental professionals and facilities included in the Companion Global
available to guide you every step Dental network are thoroughly vetted against strict guidelines, and then carefully
of the way. selected by Companion Global Healthcare.
Savings you can smile about with And many of the professionals practicing at network hospitals have trained in the
Companion Global Dental. U.S. and are members of American dental associations.

Patient-focused service Companion Global Dental’s network dental facilities cater

How does this program to international patients and have designed their facilities to center around the
work with an individual patient experience. You’ll find each facility has English-speaking staff dedicated
dental plan? to making your visit as comfortable as possible. And transportation to and from
n Review your dental plan to find the airport, as well as your appointments, will all be provided or arranged with
out exactly what is covered and Companion Global Dental.
what isn’t. You’ll find the phone
More choices Sometimes a benefit plan doesn’t cover a dental procedure you may
number on the back of your insur-
need. Or maybe you have exhausted your benefits and simply can’t afford to pay
ance ID card.
out of pocket. With the money you’ll save by traveling abroad, you may not have
n Ask if you will need any precer- to put off needed procedures or improving your smile.
tifications or preauthorizations. Significant cost savings Do your research and compare costs. You may be
Get details on how to get them, surprised at how much money you can save even when you factor in travel costs.
if necessary. Do you need a few crowns? Implants? Other significant dental work? Or are you
n When you talk to your dental interested in cosmetic dentistry? If you are putting it off because of the expense,
plan representative, take notes. you now have an option to receive dental care at a fraction of the cost.
Write down the person’s name You can have nearly any dental procedure done and take advantage of significant
and the date in case you need savings at one of our network dental clinics in Costa Rica. When you compare the
to reference it later. Ask any costs, you may be surprised at how much you can save ... enough to add in
questions you need to under- a tropical vacation!
stand your exact benefits. Tourism opportunities While you’re in Costa Rica,
n Make sure you have a current why not take in the beautiful scenery?
insurance ID card and be sure Companion Global Dental can help
to pack it with you! Always carry arrange a variety of tour packages
your ID card during your trip. so you can enjoy a wonderful
vacation between appointments.

Round-trip customer service

Companion Global Dental will
help you with all aspects of your
trip, from assisting with travel
plans to making sure you
choose a network facility.

95311 8/09 www.CompanionGlobalDental.com