American Foreign Service Association (AFSA) Group Dental Plan

The information below applies to coverage and rates for the METROPOLITAN WASHINGTON, DC area only.
Plans in other states may have regional differences. For information about available plans in other states, please contact: info@dentalinkusa.com or call toll-free 800-296-5289.

Dominion Dental does it better.

Dominion Dental Services, Inc. (DOMINION) is a managed care dental plan that has contracted with carefully selected, established members of the dental profession to deliver quality dental services to our subscribers.

Dominion provides:

• Extensive coverage
• Dental care of the highest quality at pre-determined fees
• Your choice of convenient private offices
• Treatment that emphasizes prevention and early detection of dental problems

More coverage, less cost.

Dominion offers preventive dental coverage — that means you can have healthier teeth for the rest of your life. Your Dominion dental plan offers the complete care you deserve at a price you can afford. Just compare our costs to that of the typical dentist in the Washington, D.C. Metropolitan area.

Compare and save!

average fee*

Dominion fee**

Oral Examination	$47		no charge
Fluoride Treatment	$22		no charge
Complete Series X-rays†	$79		$22
Bitewing X- rays	$26		no charge
Semi annual Cleaning	$54		no charge
Filling (3 surfaces)	$98		$45
Crown	$634		$392
Root Canal (Anterior)	$410		$235
Complete Denture	$893		$515
Extraction	$89		$48

Your savings on examinations, x-rays and cleanings alone more than pay for the plan. When fillings, crowns, root canals and other care is needed, we provide even greater savings and value.

*National Dental Advisory Services fee information 80th percentile
**$10 Co-payment per visit not included

Plan 505X benefits include:

• No charge for oral examinations
• No charge for routine semiannual cleaning
• No charge for bitewing x-rays
• No charge for topical fluoride

These procedures account for over 75% of dental services most frequently performed for adults, and almost 100% of the most frequently performed services for children. A $10 Co-Payment applies per visit.

With Dominion Dental, you and your dependents are eligible for all benefits, including children under age 19 or full time students up to 23 years of age. If your children need braces and a root canal, all in one year, Dominion Dental will cover it like no other dental plan will.

We give you more for your money.
The low bi-weekly fee for Plan 505X coverage can be automatically paid through Federal Allotment (DC/MD/VA/DE/PA); for all other areas where coverage is available, the rates are monthly and are paid by automatic bank draft.

	Premium (DC/MD/VA/DE/PA) (with Administration Fee)***	Premium (all other locations)
Subscriber Only	$ 9.00 (bi-weekly)	$17.79 (monthly)
Subscriber and One Dependent	$15.00 (bi-weekly)	$30.82 (monthly)
Subscriber and Two or More Dependents	$23.00 (bi-weekly)	$41.36 (monthly)

***These bi-weekly fees include a non-refundable charge payable to the Plan Services Coordinator for the monthly administration of the Direct Deposit payment plan.

How do I receive care?
After your effective date, simply call the dental office you selected, make an appointment, and present your membership card upon arrival.

You will receive treatment at the dental office listed on your membership card, except when an emergency arises or when otherwise directed by your Plan Dentist.

Plan Features:

• No Deductibles
• No Pre-Authorized Paperwork
• No Claim Forms
• No Maximum Annual Dollar Limits
• No Pre-existing Conditions Exclusions

For participating dental providers and information on areas other than the Washington, D.C. Metropolitan area, please use the Online Request Form.