The Dental Indemnity Plan for ASME Members helps protect your budget against expensive dental bills with important benefits paid whenever you or a covered family member see the dentist. More than 150 different types of dental services are covered ranging from preventive services, like exams, cleanings and X-rays, all the way up to major treatments, like root canals, dentures and oral surgeries.
Members And Eligible Dependents May Enroll
Your status as an ASME Member under age 65 means you are guaranteed the right to enroll in full benefits under the ASME Dental Indemnity Plan. Plus, your lawful spouse under age 65 and unmarried dependent children under age 19 (age 25 if a full-time student) are also guaranteed acceptance when they enroll in this plan (subject to state variations)..
Dental Plan Features
- You select your own dentist – guaranteed.
- Benefits are provided for more than 150 different dental services.
- Option to use the SmileMax® Dental Network
- No waiting period for preventive (dental exams, emergency treatments to eliminate pain, fluoride treatments, bitewing x-rays) services.
- Choose to have the benefits paid to you or directly to the dentist.
- Your acceptance into this plan is not subject to underwriting approval.
Option to use the SmileMax® Dental Network which can result in lower out-of-pocket costs for your dental care
This Dental Plan includes an optional PPO feature through the SmileMax® Dental Network which can help reduce your out-of-pocket expenses. The SmileMax® network is a group of dental professionals at more than 140,000 locations nationwide that have contracted to provide dental services at negotiated fees. Selecting a network dentist can also help ensure quality care, because all network dentists are screened according to a rigorous credentialing process. Members are encouraged to use a network dentist in the SmileMax network when accessing dental services. When a network dentist is selected, you will be charged pre-arranged fees that are guaranteed to be at or under the dentist’s usual fee. On average, a savings of 20 to 40 percent have been achieved nationally when using a network dentist. The Enhanced Dental Insurance Plan will continue to pay at the levels shown in the Schedule of Dental Services and you will be responsible for the difference between the network dentist’s negotiated fee and the amount paid by this plan. But your out-of-pocket costs will be significantly reduced because the network dentist’s negotiated fee is less than the dentist’s usual fee. You may continue to choose any dentist you wish. However, using a SmileMax network provider can help you save significantly. To find a SmileMax dentist, call 1-800-221-3480 or visit SmileMax Dental Provider, an online search tool . If your dentist does not currently participate in the SmileMax® Dental Network, you can contact the program administrator to obtain a nomination form to nominate him/her for membership.
As part of ASME's continuing goal to hold costs to a minimum, a $50 calendar-year deductible per person applies to dental exams, emergency dental treatments, fluoride treatments and bitewing x-rays. A $100 deductible per person applies to other types of dental treatments for each calendar year. (The family deductible is capped at three times the per person deductible per calendar year.) There is a separate deductible for option orthodontia of $500 per calendar year.
There is no waiting period for: cleanings, fluoride treatments, X-rays, exams and emergency treatments to alleviate pain. There is a six month waiting period for: sealants, basic diagnostic and restorative care along with oral surgery. For services such as major restorative, endodontic, periodontic and prosthodontic services the waiting period varies between 12 and 18 months.
Customize your Level of Coverage
Dental Indemnity includes two benefit options: Gold and Silver. Each plan covers exactly the same types of dental care. The difference is the amount of coverage for certain types of dental care. The maximum per person benefit is $1,500 per calendar year for all covered services. There is a lifetime maximum for optional orthodontia of $1,000 per person. After the deductible, this plan will pay the percentages specified below of reasonable and customary charges for covered benefits and services. Reasonable and customary means a charge not more than the dentist's usual charge and the usual charge made by most other dentists with similar training and experience in the same geographic area.
|Type I–Preventative (dental exams, emergency treatments, fluoride treatments, bitewing x-rays)
|Type II–Basic (fillings, amalgams to repair broken teeth, oral surgery, anesthesia, extractions)
|Type III–Major dental services (root canals, Bridges, crowns, inlays, dentures)
Your coverage will be effective the first day of the month coinciding with or next following the date your request for insurance is received, provided the required premium is paid. Some services are subject to a 6 or 12–month waiting period; see "Waiting Period" section above.You must be able to perform the normal activities of a person of like age and sex,with like occupation or retired status on the date your insurance is to take effect. If not, insurance takes effect on the date such activities are resumed. A dependent must not be hospitalized on the date insurance is to take effect. If so, insurance will take effect on the date he is discharged.
When Coverage Terminates
Your coverage will end the earliest of: the date the group policy ends, the end of the period for which the last premium was paid, or when membership ends. Coverage for your spouse and dependent children, if enrolled, will end when your insurance ends, if dependent's insurance ends under the group policy, on the date the person stops being your dependent or when the last premium has been paid for that person. Any persons who were previously insured for dental insurance under this plan and later voluntarily ends insurance will not be eligible to re-enroll. Such persons are no longer eligible for dental benefits under this plan.
Certificate Of Insurance
When you become insured, you will be sent a Certificate of Insurance summarizing the provisions of the Plan under which you are insured.
Payment And Claims
You can count on us to make sure your claim is handled as a top priority whenever you or a covered family member see a dentist. In fact, the money is typically on its way to you within 10 days. And this plan works in coordination with any other dental plan that you may have to make sure you get the maximum benefits you are entitled to receive. Plus, you have the freedom to choose whether benefit checks go directly to you–or your dentist–to help you stay even more in control of your dental bills.
"30–Day Free Look"
When you become an insured, you will be sent a Certificate of Insurance summarizing your insurance coverage. If you are not completely satisfied with the terms of your Certificate of Insurance, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund–no questions asked!
- Truthfully complete and sign the enrollment form. Be sure to indicated whether you are requesting coverage for your dependents.
- Make your check for the total premium contribution payable to: Administrator, ASME Insurance Program. Mail both your completed enrollment form and your check to:
Administrator, ASME Insurance Program
12421 Meredith Drive
Urbandale, IA 50398
If you have questions about your eligibility or the features of this Plan, including costs, exclusions, limitations and terms of coverage, call a Customer Service Representative toll–free at 1-800-289-2763.