Supplemental Dental Insurance

The plans advertised herein offer supplemental insurance coverage and are not major medical insurance plans.

¹ The Aflac Dental – Basic scenario includes the following benefit conditions: Dental Wellness Benefit $25, X-Ray Benefit of $10, Crowns and Other Major Restorative Benefit - ADA Code: D2722 (waiting period met) of $250.

The Aflac Dental – Standard scenario includes the following benefit conditions: Dental Wellness Benefit $50, X-Ray Benefit of $25, Crowns and Other Major Restorative Benefit - ADA Code: D2722 (waiting period met) of $325.

The Aflac Dental – Premier scenario includes the following benefit conditions: Dental Wellness Benefit $50, X-Ray Benefit of $25, Crowns and Other Major Restorative Benefit - ADA Code: D2722 (waiting period met) of $375.

AFLAC DENTAL – A81000 SERIES

This is a brief product overview only. Coverage may not be available in all states, including but not limited to NJ or NM. Benefits/premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policies and riders for benefit details, definitions, limitations and exclusions. For availability and costs, please complete the linked form above.

Aflac Supplemental Dental (A81000 Series): In Arkansas, Policies A81100RAR through A81400RAR. In Delaware, Policies A81100–A81400. In Idaho, Policies A81100RID through A81400RID. In New York, Policies NY81100 through NY81400. In Oklahoma, Policies A81100OK through A81400OK. In Oregon, Policies A81100OR through A81400OR. In Pennsylvania, Policies A81100PA through A81400PA. In Texas, Policies A81100TX through A81400TX. In Virginia, Policies A81100VA through A81300VA.

Limitations and Exclusions for residents of Arizona:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of Idaho:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of New Jersey:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of Virginia:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Coverage underwritten by American Family Life Assurance Company of Columbus. In New York, coverage underwritten by American Family Life Assurance Company of New York.

Aflac WWHQ | 1932 Wynnton Road | Columbus, GA 31999