PLAN INFORMATION

Who is eligible for this coverage?

This plan is offered to individuals and their spouse age 18+ and their unmarried dependent children (from birth to age 19 or 25 if a full-time student - subject to state requirements).  All persons listed on the Application for Coverage must reside at the same home address.

This plan of dental insurance is NOT currently available to residents of: CO, MT, ND, NE, NV, NY, VT, HI, AK, and WA.

Important Notice - "Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud."

When does my coverage start?

Coverage starts on the effective date. The effective date issued will begin on the 1st of the month (at 12:00am), following Co-ordinated Benefit Plans, Inc.’s receipt of the completed Application for Coverage form and payment of the first month plan cost.

What are my payment options?

You can pay in monthly installments by credit card (MasterCard or VISA) or auto bank withdrawal.

What services are not covered?

The following Services are not covered by the American Health Shield – Voluntary Dental Insurance plan:

- Services for injuries or conditions paid pursuant to Workers Compensation or Employer’s Liability laws;

- Services or appliances started prior to the covered person’s effective date;

- Treatment by other than a Dentist or licensed dental hygienist;

- Correction of congenital or developmental malformations, cosmetic surgery or dentistry for aesthetic reasons;

- Medications and prescription drugs;

- Services for the diagnosis or treatment of temporomandibular (TMJ/TMD) disorders;

- Inlays;

- Lost, missing or stolen appliances of any type;

- Pulp caps, maxillofacial prosthetics or myofunctional therapy;

- Services or supplies received as a result of dental disease, defect or injury due to an act of war, declared or undeclared; and

- Charges related to hospitalization or general anesthesia and/or intravenous sedation for restorative dentistry.

This is not a complete listing of plan Exclusions. For a complete listing, refer to the Policy or Certificate.

What is the Benefit Year Maximum?

The maximum amount payable for all Covered Dental Charges in any benefit year as shown in the Coverage Schedule. The Benefit Year Maximum will apply to each insured person.

Brief Statement of Policy Provisions Relating to Premiums, Renewability, and Termination

The Policy is renewable at the option of the Master Policyholder or the Insurer. Upon 31 days prior written notice, the Insurer reserves the right to change the premiums, subject to state specific requirements.  Coverage may be terminated by the primary insured or the Insurance Company upon 31 days prior written notice to the other party, or for other reasons stated in the Policy or Certificate.