Dental Care

Free Choice of Dentist

 You may choose any licensed dentist or licensed denturist practicing within the scope of his or her profession.

What the Insurance Covers

 The dental benefits described in this section apply to Active Members up to age 71 and their eligible Dependents. The insurance covers work included in a comprehensive list of dental expenses, which appears later. Many dental conditions can properly be treated in more than one way. This Plan is designed to help pay your dental expenses but not on the basis of treatment that is more expensive than necessary for good dental care. Thus, if a condition is being treated for which two or more services included in the list are suitable under customary dental practices, the benefit under the Plan will be based on the least expensive of the services.

If a dental service is performed that isn't in the list, but the list contains one or more other services that under customary dental practices are suitable for the condition being treated, then for the purpose of the Plan, the least expensive of the suitable services listed will be considered to have been performed. Please refer to the list of Exclusions for additional items that are not covered.

The final choice of treatment is always between the patient and the dentist. You are financially responsible to your dentist for cost of the dental work performed. This Plan will reimburse you to the limits described herein.

Percentage Payable

 The percentage payable is the maximum percentage of the allowed expense for which the plan will reimburse you.

 Calendar Year Maximum

 The Calendar Year Maximum is the maximum amount the plan will allow any one individual for Dental Care Benefits in a single calendar year.

 Pre-Determination of Benefits

 Pre-determination of benefits permits the review of the proposed treatment in advance and allows for a solution of any questions before, rather than after, the work has been done. Additionally, both you and the dentist will know in advance what the Plan will allow assuming you, or the Dependent, remain covered.

 Treatment Plan: 

• A “Treatment Plan” is strongly recommended when dental work is expected to exceed $500.
• A "Treatment Plan" is the dentist's report that itemizes the dentist's recommended services, shows the dentist's charge for each service, and is accompanied by supporting X-rays, or a letter of expertise.
• The "Treatment Plan" will be returned to the dentist, with a copy to you, showing the estimated benefits.

What An "Eligible Charge" Is

 An "eligible charge" is one the dentist makes to you for a covered dental service furnished to you or a covered Dependent, provided the service is included in the list of Covered Dental Expenses and not listed under Exclusions. All expenses are assessed on a reasonable and customary basis. Lab fees may be cut back accordingly. A charge is considered incurred on the date the service is received, rather than on the date the charge is made. In the case of root canal therapy, crowns, dentures or bridgework, which may require multiple appointments, the date the expense is incurred will be the date the service is finally completed. For dentures or bridgework, this date will be the date the prosthetic device is installed. For crowns, this will be the date the permanent crown is installed and for root canal therapy, this will be the date the canal is closed.

Termination of Benefits

 No benefits for Covered Dental Expenses will be paid for expenses incurred after the policy terminates, or after the individual’s coverage terminates.

Survivor Extension of Benefits

 Your surviving Spouse and surviving Dependent Children, including any Child conceived before and born after your death, will be insured under the Dental Care benefit on the later of the following dates:

• the date of your death, or
• if disabled on the date of your death, the date the survivor is no longer entitled to benefits under Extension of Dental Care benefits.

 The Dental Care benefits in force at the time of your death will not be affected by any increase, decrease or by termination of the Survivor Benefit or Group Policy.

• The Survivor Benefit terminates the earlier of:
• the date of death of the surviving Spouse/Dependent, or
• the date which is two years from the date of your death, or
• the date your Spouse remarries, or
• the date on which the surviving Child ceases to qualify as a "Dependent", or
• the date your Dependents become insured under another group policy providing similar benefits.

 Any extended benefits payable are subject to the provisions and limitations of the plan. This extension is provided under the terms of the plan and terminates if the plan or benefit is terminated.