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Summary
of Benefits
Vantage Choice
Co-Insurance Plan (a)
In-Network
Out-of-Network(d)
Vantage Care
Co-Payment Plan (b)
In-Network Only
Vantage Access
Discount Plan (c)
In-Network Only
Preventive
Office visit, cleaning, oral exam and x-rays
100%
after $10 co-pay
 80%(d)
100%
after $10 co-pay(*)		 60-70%
average discount
Basic
Simple extractions and fillings
80%
20-30% discount in waiting period
 60%(d)
75-80%
average savings(*)		 30-40%
average discount
Major
Crowns, bridges, dentures, inlays, periodontics, endodontics and oral surgery
50%
15-25% discount in waiting period
 40%(d)
50-60%
average savings(*)		 20-30%
average discount
Orthodontics
15-25% discount
 N/A(d)
15-25% average discount 15-20% average discount
Waiting Periods
 6 months basic / 12 months major None None
Deductible
 $50 per subscriber per calendar year
for basic and major services		 None None
Annual Maximum
 $1,000 per subscriber
20-30% discount on all covered services after the annual maximum has been reached		 None None
Additional Information
For subscribers ages 65 and older there is a $25 office co-pay and $100 deductible per subscriber per calendar year.
TDA PPO Network
15-25% discount on specialist services: Periodontist, Endodontist, Prosthodontist, Pediatrics and Oral Surgeon.
TC-4000 Network
20% discount on specialist services: Periodontist, Endodontist, Prosthodontist, Pediatrics and Oral Surgeon.
TDA PPO Network
Payment Method
Family size
Monthly
Monthly
Annual
Monthly
Annual

All Plans allow Monthly payments by Visa, MasterCard, Discover, American Express or automatic bank account withdrawals.

Vantage Care and Vantage Access Plans offer more savings with a discounted annual payment rate.

Automatic payment comes out on the 20th of each month.

There is a one-time enrollment fee of $10.00 for all new applications. Please include it with your first month premium payment.

Plans start on the 1st of each month.
Subscriber
$23.87
Subscriber + 1
$44.97
Subscriber + 2
$59.93
Subscriber + 3
$73.95
Subscriber + 4
$88.78
Subscriber + 5
$102.86
Subscriber + 6
or more
$128.98
Single $16.35 $180.00 Single $6.25 $49.00
Two Party $32.70 $360.00 Two Party $8.25 $73.50
Family $53.10 $584.00 Family $10.25 $98.00

(a) Vantage Choice Plan insured by American National Life Insurance Company of Texas, Galveston, Texas. (b) Vantage Care Plan insured and underwritten by Total Dental Administrators. For complete fee schedule please refer to the plan certificate. (c) Vantage Access Plan is not insurance; it is a reduced fee plan comprised of participating dental providers who have agreed to accept a discounted fee for their services. (d) All payments made by the plan are based on the network fee schedule. For complete details of the coverage please refer to the plan certificate. Plans may vary by state.

(*) See co-pay schedule.

Vantage Choice dental insurance policy issued under form series DENT06-POL. Available to members of the National Consumers Advantage Association (NCAA). The benefits illustrated are a summary only; these policies have exclusions and limitations.

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Vantage Choice
Vantage Care
Vantage Access

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