Modules 4A & 4B - Dental & Optical
Reimbursements under these two modules are effected at 50-80%, but they will not in any event
exceed the following amounts or the respective annual maximums of Module 4A: EUR 5,000/
GBP 3,500/USD 5,000 and Module 4B: EUR 7,500/GBP 5,000/USD 7,500.
All amounts are in EUR / GBP / USD
| |
Module 4A |
Module 4B |
| Routine Dental Treatment |
80% |
80% |
80% |
80% |
80% |
80% |
| Examinations, max. |
20 |
15 |
20 |
40 |
30 |
40 |
| Tooth cleaning, max. |
40 |
25 |
40 |
60 |
35 |
60 |
| Fillings per tooth, max. |
60 |
40 |
60 |
110 |
65 |
110 |
| Root treatment per tooth, max. |
70 |
45 |
70 |
140 |
96 |
140 |
| Tooth extractions per tooth, max. |
40 |
20 |
40 |
100 |
60 |
100 |
| Surgery, max. |
73 |
50 |
81 |
174 |
120 |
195 |
| X-ray, max. |
40 |
20 |
40 |
50 |
35 |
50 |
| Anesthesia, max. |
15 |
10 |
15 |
20 |
15 |
20 |
| Special assistance, max. |
40 |
30 |
40 |
80 |
52 |
80 |
| Special Dental Treatment |
50% |
50% |
50% |
50% |
50% |
50% |
Bridgework
Crowns
Periodontitis
Orthodontics (tooth adjustment)
Dentures |
Special dental treatment per policy
year, max. |
2,000 |
1,500 |
2,000 |
3,000 |
2,250 |
3,000 |
| Glasses and Contact |
Module 4A |
Module 4B |
| Lenses |
80% |
80% |
80% |
80% |
80% |
80% |
| One pair of glasses (excl. frames) per policy year, max. |
160 |
100 |
160 |
220 |
150 |
220 |
| Contact lenses, per policy year, max. |
100 |
60 |
100 |
130 |
80 |
130 |
| Contact lenses, per policy year, max. |