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.
Members And Eligible Dependents May Apply
You and your eligible dependents may apply 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.)
Dental Plan Features
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 benefits.
Deductibles
The calendar year deductible is $50 per insured person, up to $150 maximum per family unit. The deductible does not apply to preventative services. It is applied against insurance–covered expenses, not billed charges.
Waiting Period
Preventive, Diagnostic, Restorative and Adjunctive Services are provided immediately. Endodontics and Oral Surgery have a 6–month waiting period. All other benefits have a 12–month waiting period. Once you have been enrolled under the plan for 12 consecutive months, you are eligible for benefits under Restorative–Major, Periodontics, Prosthetics–Removable and Fixed Bridge. For orthodontics coverage for insured dependent children under age 19, there is a 12–month waiting period.
Economical Plan Cost With Orthodontics
Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.
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IEEE Group Enhanced Dental Insurance Rate Chart*
Current 2009 Rates
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Monthly
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Quarterly
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Member Only
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$38.67
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$116.00
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Member + 1
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$68.63
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$205.90
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Family
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$94.73
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$284.20
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Economical Plan Cost Without Orthodontics
Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.
|
IEEE Group Enhanced Dental Insurance Rate Chart
Current 2009 Rates
|
|
|
Monthly
|
Quarterly
|
|
Member Only
|
$38.67
|
$116.00
|
|
Member + 1
|
$64.77
|
$194.30
|
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Family
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$83.62
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$250.85
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Payment Options
You are able to choose between two premium payment options, whichever one best suits your needs.
Option 1: Pay through Automatic Monthly Check Withdrawal. This saves you the time spent writing checks and remembering due dates.
Option 2: 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 for (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 for (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 as specifically provided by the group policy.
- For charges that would be given free of charge if the person was not insured.
- For services in connection with war or any 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 recommended, approved and certified 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.
- For charges that are 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 6 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. In addition to the above, coverage for dependents will end when they are no longer eligible as your dependent; or dependents'insurance is discontinued under the group policy.
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 IEEE 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.
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. V–610,270, 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.
AG–6173