• Providing Dental Insurance, Not Just A Discount Plan: Dental insurance helps protect you when you need it most, paying for emergency care and specialty dental treatment as well as your preventive care. It provides you with an effective way to manage the rising costs of dental care.
   
• Visit Any Dentist You Want: You never have to change dentists. This means you're always guaranteed the right to go to your own dentist.
   
• Guaranteed Acceptance: Your acceptance is not subject to underwriting approval. In other words, you cannot be turned down for coverage as long as you meet eligibility requirements and the Plan is available to residents of your state.
   
• Covers 155 Dental Services:* The Plan covers you for procedures such as crowns, root canals, periodontics, oral surgery, and more. Orthodontics is also available for insured dependent children under age 19.
   
• Choose Whether Benefits Are Paid Directly To You Or Your Dentist
   
• No Waiting Period For Preventive, Diagnostic, Restorative or Adjunctive Services

* Some services require a waiting period. See the Plan Details section in the Tell Me More section for more information.

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 175 Water Street, New York, NY 10038. It is currently authorized to transact business in all states plus DC, except PR. 

Policies issued by The United States Life Insurance Company in the City of New York (US Life). Issuing company US Life is responsible for the financial obligations of insurance products and is a member of American International Group, Inc. (AIG). Products may not be available in all states and product features may vary by state. Policy # V-610,270 Form # G-19000.

This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of the group policy.

Here’s How The Plan Works

The plan provides benefits for diagnostic and preventive care as well as most forms of specialty dental treatment. You may go to any dentist you wish.

The Schedule of Dental Services identifies the maximum allowable benefit you and your dependents receive when a procedure is performed. The dollar amount assigned to each procedure is the maximum you receive, not to exceed actual charges. Under this Plan, you can request to have benefits paid either directly to the dentist or you can be reimbursed for the benefit.

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.

Members And Eligible Dependents May Enroll

You and your eligible dependents may enroll for coverage. Eligible dependents include a lawful spouse and dependent children typically under age 21 (age 25 if a full–time student). (Subject to state variations.) All persons who were previously insured for dental insurance under this plan and later voluntarily ended insurance will not be eligible to re-enroll for a period of two years following the date insurance was voluntarily ended.

Dental Plan Features

• You select your own dentist – guaranteed.
• Benefits are provided for 155 different dental services.
• Option to use the SmileMax® Dental Network
• No deductible for preventive services.
• No waiting period for preventive, diagnostic, restorative (except major) or adjunctive servies.
• Choose to have the benefits paid to you or directly to the dentist.
• Your acceptance into this plan is not subject to underwriting approval.

Annual Maximums

You and your covered dependents are entitled to receive up to $1,200 maximum in dental benefits each calendar year after the cash deductible is satisfied. A lifetime maximum benefit of $850 applies to orthodontic services for insured dependent children under age 19.

Deductibles

The calendar year deductible is $50 per insured person, up to $150 maximum per family unit. The deductible does not apply to preventive services. It is applied against insurance–covered expenses, not billed charges.

Waiting Period

Preventive, Diagnostic, Restorative (except major) and Adjunctive Services are provided immediately. Endodontics and Oral Surgery services have a six–month waiting period. All other services have a 12–month waiting period. Once you have been enrolled under the plan for 12 consecutive months, you are eligible for services under Restorative–Major, Periodontics, Prosthetics–Removable and Fixed Bridge. For orthodontic services for insured dependent children under age 19, there is a 12–month waiting period.

Economical Plan Cost With Orthodontics

Rates as of 02/2017

Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.

Economical Plan Cost Without Orthodontics

Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.

Schedule of Benefits

Click here to view the Schedule of Dental Services.

Payment Options

You are able to choose between two premium payment options, whichever one best suits your needs.

Option One: Pay through Automatic Monthly Check Withdrawal. This saves you the time spent writing checks and remembering due dates.

Option Two: Pay through direct billing on a quarterly basis.

 

Other Important Information

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, onlays 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 mouthguards; (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 fluoride; 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 or procedure, except to the extent 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 or treatment of a condition for which you are entitled to or eligible for benefits under any Workers Compensation Act or similar law.
• For charges that are applied toward satisfaction of a deductible, if any.
• For services that are not recommended, approved and certified as necessary and reasonable by a dentist.
• 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 after a person’s insurance ends; however, dental benefits may be provided as described in the Benefits After Insurance Ends provision outlined in the Certificate of Insurance.
• For charges incurred for treatment which is not essential for the necessary care or treatment of the injury or sickness involved.

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.

Effective Date

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 six or 12–month waiting period; see "Waiting Period" section above.

When Coverage Terminates

Your dental coverage will be terminated only if you fail to pay the appropriate premium when due; the group policy is discontinued; or insurance ends for your class. Coverage for dependents will 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.

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

Under the ASHA Group Enhanced Dental Insurance Plan, you can request that the benefits be paid either directly to your dentist, or you can be reimbursed for the benefit. Once you are accepted into the Plan, you will have a 31–day grace period for your payment of renewal premiums.

Consider Your Eligibility

Before you request coverage, you must be a member in good standing of ASHA. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, see the ASHA home page.

"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!

To Enroll

Truthfully complete and sign the enrollment form. Be sure to indicate whether you are requesting coverage for your dependents.

Make your check for the total premium contribution payable to: Administrator, ASHA Group Insurance Program.

Mail both your completed enrollment form and your check to:

Administrator,
ASHA Group 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 1-866-795-9340.