Plan Details
You, your spouse and children are guaranteed acceptance.
You, your lawful 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. Click to display the Schedule of Dental Services.
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 Group Dental Insurance Plan, you can choose to use your own dentist.
No waiting period for preventive, diagnostic restorative or adjunctive 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
services; a 12-month waiting period for all other services. After 12 consecutive months of coverage, you qualify for restorative-major, periodontics, prosthetics-removable, and fixed bridge
services. For orthodontics services for insured dependent children under age 19, there is 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 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. This Dental 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.
Deductible of $50/person or $150/family unit, per calendar year.
For all services, there is a deductible of $50 per insured person/$150 per family unit, per calendar 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 orthodontic services after the deductible is satisfied. Coverage for orthodontic services 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, 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.
All billing modes except annual will include a $2.00 billing fee. To avoid the fee, select EFT as a safe and secure payment option.
Economical group rates.
Because you’re an association member, you qualify for members-only group rates.
Your coverage will terminate only if you cease to be a member of your association.
Your coverage will terminate only 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 your dependents will be end if your insurance ends, dependents’ insurance ends under the group policy, the person ceases to be a dependent or premium is not paid for the dependent when due. 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. To see the full list of exclusions this plan does not cover, see 'Exclusions' below.
Goes with you wherever you go—change jobs, move, etc.
With this Group Dental Insurance Plan, it goes with you wherever you go—whether you travel, plan to move or switch jobs in the future.
Enroll conveniently right now—no salesperson will contact you.
It’s easy to enroll in your association Group Dental Insurance Plan. Everything is handled the modern, convenient way through this secure site. No salesperson will call you. You can also visit the Forms section to download a no-obligation enrollment form and brochure containing detailed plan information and plan provisions, including costs, exclusions, limitations and terms of coverage.
Once you receive your Certificate of Insurance, if you're not satisfied within the first 30 days, we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.
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 (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 (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 group policy.
- For charges incurred for treatment which would be given free of charge if you were not insured.
- For charges incurred for treatment which results from a war or an 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, if any.
- 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 incurred for treatment which is given after a person’s insurance ends, regardless of when the injury or sickness occurred.
- For charges incurred for treatment which is 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–227,633, 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 products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.
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