Group and Individual Dental Insurance Forms for Landmark Dental Agents

Dental for Individuals and Families

We Know the Way
Our Personal Dental Plan provides individuals and families with dental benefits and preventative care. Landmark Dental brings full dental insurance benefits to people who don't have access to employer sponsored dental insurance.

Insurance Benefits You Can Count On
Our plan offers coverage for...
Preventive & Diagnostic Services
Basic Restorative Services
Major Services
View our plan coverage details below.

Benefits For All
Our Personal Plan includes plans for...
Individuals
Individual Plus One
Families
Seniors: Our plans cover individuals from age 18 and up.

Use Any Dentist
Our dental plans cover you with any dentist, but your best benefits are with preferred dentists in our network. Over 47,000 belong to our network. Click here to find a dentist in your area.

Enrollment
It couldn't be easier. Click below to calculate your premiums, and then enroll in your desired plan. Enroll Here

Payment can be made by credit card or bank draft.

Want a paper enrollment form?
Download a Personal Plan Paper Registration Form:
(note: Large 3.5mb download) (pdf document)
E-Mail our office to have a paper registration form mailed to you.

Calculate Your Premiums and Enroll Online
View Dental Expenses Not Covered (pdf document)
Frequently Asked Questions
Additional Plan Enrollment Information
Complete Rate Grid for Personal and Group Plans (pdf document)

Calculate Your Premiums and Enroll Online

Compare Our Rates
Our Rates are Great! Calculate your rates in seconds* and compare, you'll like what you see.
* No commitment or personal information required

Preventive & Diagnostic Services
Coverage One initial examination per calendar year Two prophylaxis (cleaning) per calendar year.
	Preferred Provider Pays 100% of PPO fee $50 annual deductible* No waiting period	Non-Preferred Provider Pays 80% of PPO fee $50 annual deductible No waiting period

Basic Restorative Services
Coverage Bitewing x-rays, two per calendar year. One fluoride treatment per calendar year for dependents under age 16. Simple restorative services (fillings).
	Preferred Provider Pays 70% of PPO fee $50 annual deductible* 6-mo. waiting period	Non-Preferred Provider Pays 50% of PPO fee $50 annual deductible 6-mo. waiting period

Major Services
Coverage Oral surgery Bridge Periodontics		Crown Endodontics
	Preferred Provider Pays 50% of PPO fee $50 annual deductible* 18-mo. waiting period	Non-Preferred Provider Pays 50% of PPO fee $50 annual deductible 18-mo. waiting period

* Combined Preventive, Basic and Major calendar year deductible maximum is $150 per family. combined calendar year maximum benefit amount for Preventive, Basic and Major is $1,000.
Note: This is a general outline of covered benefits and does not include all the benefits, limitations, and exclusions of the policy. See your certificate for details.
Claims will not be applied to your deductible until the applicable waiting period has been met.

S10569 (Rev 4/05)