You, your spouse and dependent children are guaranteed acceptance.
You, your spouse and dependent children (typically under age 21 or age 25 if full-time student) are guaranteed acceptance—there are no long forms to complete, dental health questions to answer or exams to take. You're already in. (Subject to state variations).
Benefits provided for 155 different dental services.
This Group Dental Insurance Plan is not a discount type plan you can get elsewhere. This plan provides comprehensive coverage for more than 155 different dental services, including diagnostic, preventive and specialty dental treatments.
You have freedom to choose any dentist you want.
With many employer-provided or other types of dental plans, you're required to use networks, preferred lists or referrals for specialty treatment. But with this Dental Plan, you can choose to use your own dentist.
No waiting period for specified services.
Preventive, diagnostic, restorative (except major) and adjunctive services are all provided immediately with no waiting periods. However, to keep your rates economical, there is a 6-month waiting period for endodontics and oral surgery; a 12-month waiting period for all other benefits. After 12 consecutive months of coverage, you qualify for restorative-major, periodontics, prosthetics-removable and fixed bridge. Insured dependent children under age 19 qualify for orthodontic coverage after a 12 month waiting period.
Benefits can be paid directly to you or your dentist—it's your choice.
You can choose to have your benefits paid directly to you or to your dentist, whichever you prefer.
Option to add the Benefit Builder to your plan, which can give you a discounted fee for dental care.
This option uses a dental network and builds upon the existing benefits you receive through this Dental Plan. Basically, it offers you a discounted fee for dental care. If you choose to visit a provider in the Benefit Builder Network, you will receive a discount on covered services. This increases your out-of-pocket savings on dental costs and gives you a second way to save. This option is not a part of the Dental Plan policy—benefit reimbursement is based on the discounted fee.
If you have a dentist you really like who is not a member of the network, you don't have to change dentists. You will still receive the insurance benefit provided by the group policy—and save money. However, we are pleased to provide this Benefit Builder option if you choose it.
Deductible of $50/person or $150/family unit.
For all services, there is a deductible of $50 per insured person/$150 per family unit, per calender year. The deductible is applied against insurance-covered expenses, not billed charges.
You and your covered dependents are entitled to receive up to $1,000 each in benefits.
You and your covered dependents are entitled to receive up to $1,000 each in benefits per calendar year, and up to $850 lifetime maximum for orthodontics after the cash deductible is satisfied. Coverage for orthodontics applies only to insured dependent children under age 19.
Your coverage will be effective the first of the month following receipt.
Your coverage will be effective the first of the month following receipt of your enrollment form and first premium payment.
You can choose between three premium payment options, whichever one best suits your budget.
- Automatic monthly check withdrawal (EFT Option), which saves you time and money on checks and stamps and remembering payment due dates.
- Credit card payment on a quarterly basis.
- Direct bill on a quarterly basis.
Select Annual Billing or Electronic Funds Transfer (EFT) to avoid a $2.00 billing fee.
Economical group rates.
Because you're an association member, you qualify for members-only group rates.
Your coverage will terminate if you cease to be a member of your association.
Your coverage will terminate if you cease to be a member of your association; you fail to pay the appropriate premium when due; or the group policy is discontinued. Coverage for dependents will end when they are no longer eligible as your dependent. All persons who were previously insured for dental insurance under this plan and later voluntarily end insurance will not be eligible to re-enroll for a period of two years following the date insurance was voluntarily ended.
Exclusions keep your rates economical.
To keep your rates economical, there are some things the plan does not cover.
Goes with you wherever you go—change jobs, move, etc.
With this Dental Plan, it goes with you wherever you go—whether you travel, plan to move or switch jobs in the future.
Exclusions
No benefits will be paid for expenses incurred:
- For any portion of a charge for any service in excess of the Scheduled Benefit shown in the Schedule of Dental Services.
- For any procedure not listed as a Scheduled Benefit in the Schedule of Dental Services.
- For overdentures and associated procedures.
- For cosmetic procedures, including charges for porcelain or other veneer crowns, pontics, and porcelain or other veneer facings on crowns or pontics to replace molars.
- For the replacement of full and partial dentures, bridges, inlays, on-lays or crowns that can be repaired or restored to normal function.
- For implants; and for (a) the replacement of lost or stolen appliances; (b) the replacement of orthodontic retainers; (c) athletic mouthguard; (d) precision or semi-precision attachments; (e) denture duplication or for; (f) sealants, except as specifically provided in the Schedule of Dental Services. For oral hygiene instructions; and for (a) plaque control; (b) the completion of a claim form; (c) acid etch; (d) broken appointments; (e) prescription or take-home flouride; or for (f) diagnostic photographs.
- For services and procedures that are begun, but not completed by the end of the month in which coverage terminates.
- For charges in connection with an orthodontic service, except as specifically provided by the policy.
- For those services for which there would be no charge in the absence of insurance or for any service or treatment provided without charge.
- For services in connection with war or any act of war.
- For care and treatment of a condition for which you are entitled to and eligible for benefits under any Worker's Compensation Act or similar law.
- For charges that are applied toward satisfaction of a Deductible.
- For services that are not approved by the Council of Dental Therapeutics of the American Dental Association.
- For charges incurred for treatment which results from intentionally self-inflicted injury.
- For charges incurred for treatment which is given by a person's spouse or his or his spouse's father, mother, son, daughter, brother or sister.
- For charges incurred for treatment which is given by a person's employer or an employee of such employer.
- For charges that are given after a person's insurance ends, regardless of when the injury or sickness occurred.
- For charges that are not essential for the necessary care or treatment of the injury or sickness involved.
- For services that are not recommended, approved and certified as necessary and reasonable by a dentist.
- All person who were previously insured for dental insurance under this plan and later voluntarily end insurance will not be eligible to re-enroll for a period of two years following the date insurance was voluntarily ended.
This plan is underwritten by The United States Life Insurance Company in the City of New York, NAIC No.70106, domiciled in the State of New York with a principal place of business of 70 Pine Street New York, NY 10270. It is currently authorized to transact business in all states plus DC, except PR. This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. G-233,608, Form No. G-19000. Coverage may vary or may not be available in all states.
The underwriting risks, financial and contractual obligations and support functions associated with the products issued by The Unites States Life Insurance Company in the City of New York (United States Life) are its responsibility.
AG - 7189T