Dental Insurance

 

 

Wellness Benefit

The plan pays the amount shown in the Schedule of Dental Procedures, less the copayment. This benefit is payable two times during a coverage year, with at least 150 days between the two visits. Each wellness visit by you or your insured dependents is subject to a copayment.

Copayment - Amount you pay out of pocket for each dentist office visit for wellness services.

Deductible

Thedeductibleamountmustbesatisfiedeachyearyouare covered under the plan. The deductible applies to all services except those covered under Wellness Services. (The copayment may not be used to satisfy either your or your dependent's deductible).

Insured Person Family

Insured Percent

TheplanpaystheamountshownintheScheduleofDental Procedures, times the percent shown. If the charge for the procedure is greater than the amount shown, you pay the difference between the amount shown and the cost of the procedure.

Category 1 - Wellness Benefit
Category 1 - Other Preventive Services (subject to deductible)
Category 2 - General Services (subject to deductible) Category 3 - Special Services (subject to deductible) Category 4 - Orthodontic/Braces Services (subject to deductible - limited to dependent children under age 19)

* No benefit is available for these services during the first 6 months of the first coverage year. Refer to the Elimination Period below.

Elimination Period

The period of time you must be insured before we pay benefits. We will not pay for services performed during this period, except for those covered under the Dental Wellness Benefit.

Category 1 - Wellness Benefit
Category 1 - Other Preventive Services Category 2 - General Services
Category 3 - Special Services
Category 4 - Orthodontic/Braces Services

Annual Plan Maximum

The maximum amount the plan will pay for dental treatment for each covered person in a coverage year.

Category 1, 2 & 3 Services
Category 4 Services - Orthodontia/Braces available to dependent children under age of 19.

 

 

 

Heritage Choice Dental Plan

Eligibility - You may enroll in this plan if you meet the eligibility requirements of your employer. This usually requires that you are a full- time active employee, and may require that you have been employed for a period of time, called a waiting period. Dependent Insurance – your legal spouse and your children are eligible for insurance under your certificate. (You must enroll for employee insurance in order to add your dependents.) Coverage for your child will end on the issue day of the month that follows when the child reaches age 26 or otherwise does not meet the requirements of an eligible dependent. If your spouse is also an employee, you may not be insured as both an employee and as a dependent.

Enrollment - You must enroll within 31 days of the date you first become eligible. If you do not, and later decide to enroll, you must wait until the annual enrollment period for your group. If you acquire a dependent after your insurance is effective, you may enroll that dependent within 31 days of the date of marriage, birth, adoption, etc. There is no other provision for enrolling other than during the annual enrollment period. This is a one-month period, usually just before the group policy anniversary date. You will be notified of the eligibility requirements and annual enrollment period that apply to your group.

Termination - Employee Insurance will terminate on the earliest of: the date your employment terminates or you are transferred to a class not eligible for the insurance; the last day for which your premium has been paid; or the date the Group Policy terminates. Your Dependent Insurance will terminate on the earliest of: the date your Employee Insurance terminates; the last day for which your Dependent premium has been paid; the date coverage for dependents is terminated under the Group Policy; or, the date any of your dependents cease to be dependent as defined in the policy.

COBRA Continuation - Since this plan is employer-sponsored, it is subject to the same federal COBRA continuation requirements that apply to medical plans. In general, this allows you to continue your insurance under the group policy for 18 months after your employment terminates. If your dependent would lose coverage due to your death, divorce, or attainment of the limiting age for eligibility of dependents, the coverage may be continued for up to 36 months. If the group policy is terminated by the employer before the end of the COBRA continuation period, you are entitled to be covered under a replacement group plan.

Portability Privilege - If you lose coverage at the end of your COBRA continuation period, or if your employer terminates the group policy and does not replace it with another group dental plan, you will be eligible for portability coverage. This means you continue the same benefits you had under the group policy, but pay your premiums direct to American Heritage Life Insurance Company. You will no longer be covered under the group policy, but will continue to receive the benefits described in your certificate of insurance.

Certificate of Insurance - After you enroll, you will be given a certificate of insurance that will show your name, effective date, and whether you have dependent coverage. It will also include the complete Schedule of Dental Procedures. Coverage years for you and for your dependents, begin on your effective date.

 

 

 

 

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