What are the out-of-network benefits for services?

Under the Low Plan, eligible dental charges from providers not participating in the designated PPO network will be reimbursed no higher than the PPO allowed amount. You are responsible for any provider charges billed over the allowed amount in addition to “you pay” amounts identified in the summary of benefits. Under the High Plan, eligible dental charges by providers not participating in the designated PPO network are reimbursed based on Renaissance Life & Health Insurance Company of America’s determination of a maximum allowed amount that is representative of the 80th percentile of usual charges for services in the same geographic area.