Why risk big dental bills—or your loved ones' health? As an ASHA Member under age 65, you are guaranteed the confidence of being able to keep your family smiling!

Welcome to the exclusive ASHA member benefit that helps insulate your wallet against pricey dental bills. Currently authorized on a guaranteed acceptance basis for ASHA members and their families.

• Covers more than 150 different types of dental services. The Dental Indemnity Plan for ASHA 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.
• Guaranteed Acceptance. As an ASHA Member, you are guaranteed acceptance. You cannot be turned down for this ASHA benefit. You will not need to provide an extensive history of past dental treatments. You will not answer lengthy questions to "prove" you qualify. This exclusive entitlement is yours for the asking.
• See the dentist of your choice. You are completely free to see any dentist you prefer-whether it's a family dentist you've known for years or a highly respected specialist to handle a major dental issue.
• Discounted group rates help keep costs down. Dental Indemnity starts out with money-saving group rates negotiated through the group buying power of ASHA's members.

Good health begins with good dental health. Learn how you can benefit from the ASHA Dental Indemnity Plan. Or download an enrollment form. Click on the buttons at right.

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-610,409 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.

When you and your family are covered by the ASHA Dental Indemnity Plan, you benefit from:

• The confidence of guaranteed acceptance—you can't be denied coverage
• The relief of discounted group rates to help you control your costs
• The freedom to visit the dentist you prefer, without a referral
• The convenience of benefits paid to you or your dentist

Here’s How The Plan Works

The Dental Indemnity Plan for ASHA 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 ASHA Member under age 65 means you are guaranteed the right to enroll in full benefits under the ASHA 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.

Deductibles

As part of ASHA'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.

Waiting Period

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.

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 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!

To Enroll:

• 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, ASHA Insurance Program. Mail both your completed enrollment form and your check to:
  
  Administrator, ASHA 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 866-795-9340.

Economical Plan Cost Without 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 With Orthodontics

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

Exclusions

Charges for the following services or devices are not covered:

1. Oral hygiene, plaque control, diet instructions
2. Precision attachments
3. Treatment which:
   • Does not meet accepted standards of dental practice; or
   • Is experimental in nature

• Orthodontic charges for:
  • Lost or broken appliance
  • Class 1 malocclusions
• Appliances or prosthetic devices used to:
  • Change vertical dimension;
  • Restore or maintain occlusion, except to the extent that this benefit section covers orthodontic benefits;
  • Splint or stabilize teeth for periodontic reasons;
  • Replace tooth structure lost as a result of abrasion or attrition; or
  • Treat disturbances of the temporomandibular joint
• Cosmetic services including but not limited to:
  • Characterizing and personalizing prosthetic devices
  • Making facings on prosthetic devices for any tooth in back of the second bicuspid
• Replacement of any appliance or prosthetic device unless:
  • The appliance or device is at least 10 years old and cannot be made usable; or
  • The appliance or device is damaged, while in the insured person's mouth in an injury which occurs while insured, and it cannot be repaired
• Replacement of a lost, stolen or missing appliance or prosthetic device
• Making a spare appliance or device
• Services or devices for which no charge is made.

General Exclusions

No medical care benefits will be paid by this policy for charges incurred for treatment which:

1. Is given after a person's insurance ends, regardless of when the injury or sickness occurred. However, medical care benefits may be provided in the Benefits After Insurance Ends provision of a given benefit section.
2. Is not essential for the necessary care or treatment of the injury or sickness involved.
   NECESSARY CARE OR TREATMENT means care, treatment, services or supplies which are: 
   • • Recommended, approved or certified by a physician as necessary and reasonable, and
     • Commonly viewed by the American Medical Association as being proper treatment
   • • To train a person for a job or to educate him, or
     • Experimental in nature.

3. Would be given free of charge if the person was not insured.

However, medical care benefits will be paid for covered charges incurred by a state for medical assistance to an insured person under Title XIX of the Social Security Act of 1965.

4. Results from a war or an act of war.

5. Results from intentionally self-inflicted injury.

6. Any care or supply not listed as a covered expenses shown in the Coverage Schedule.

7. Dental care or supplies furnished in a facility operated under the direction or at the expense of the U.S government (or its Agency) or by a Physician or Dentist employed by such a facility.

8. Dental care or supplies resulting from taking part in the commission of an assault or felony.

9. Dental care or supplies due to an injury during the course of employment for pay, profit or gain.

10. Insurrection;

11. Atomic explosion or other release of nuclear energy.

12. Personal supplies for care and instructions in dental hygiene, unless used in a Physician’s Office.

13. Services or materials of a cosmetic nature or repair of congenital malformation solely for cosmetic purpose, unless:

a. As a result of, and within 24 months of an accident while insured, or
b. Treatment of congenital defects of a newborn baby

14. Dental procedures performed by a licensed dental hygienist, unless under the supervision and direction of a licensed dentist.

15. Prescription drugs, unless a covered expenses shown in the Coverage Schedule.

16. Orthodontic care, treatment or supplies, unless covered by rider.