The Dental Plan is an indemnity plan. Under this program, covered services are reimbursed as a percentage of the "Usual and Customary" charges for that service in the state where the charge is incurred.
Under this program, insured members may use any dentist they choose. If you were previously a member of a dental plan requiring the use of a specific dentist, you may continue to use that dentist if you so choose, but it is not a requirement of the Dental Plan.
Calendar Year Maximum
AFTER THE ANNUAL DEDUCTIBLE THIS PLAN WILL PAY:
All eligible members of APWU who are actively at work, or Retirees able to perform normal duties of a person of same age and sex (including dependents) are eligible to enroll. An eligible dependent is the member's spouse and unmarried children from birth to age 19 - extended to age 25 if a full time student. (Subject to state variations)
The Deductible is shown in the coverage Schedule. The Deductible is an amount of covered dental charges incurred by an insured person before benefits will be paid.
The maximum amount payable for all Eligible Dental Expenses in any calendar year is shown in the Coverage Schedule. The Calendar year maximum will apply to each insured person.
This means a charge that does not exceed the Dentist's usual charge and the usual level of charges being made by other providers of dental services with similar training and experience in the same geographic area.
The period of time the insured person must be continuously covered under the group policy before the insured is entitled to be reimbursed for covered dental charges. (see Coverage Schedule)
Expenses must be incurred while the Policy is in force and the person is covered by the Policy. To be an Eligible Expense, the dental service must be performed by a licensed Dentist acting within the scope of this license to: (1) render dental services; (2) perform dental surgery (3) administer anesthetics for dental surgery.
Coverage will become effective on the day your activation form and first premium is received and accepted.
DATE INSURANCE ENDS:This coverage will end on the earliest following date: when the group policy ends; when the premium is not paid when due; when the member leaves the union; with respect to the spouse, the date the spouse is no longer a legal spouse; or with respect to the children, the date the children are no longer dependent.
The Plan will not pay benefits for:
A complete list of limitations and exclusions is provided in the certificate of insurance.
All covered dental services must be provided by, or under the direct supervision of a dentist.
Charges must be incurred by an insured person while he is insured in order to be covered charges:
Once you receive your certificate of insurance, if you're not 100% satisfied within the first 30 days, we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.
Call the following toll-free number 1-800-422-4492
You must notify the Voluntary Benefits Plan of any address change, union status change, life status change (i.e., marriage, divorce, or name change) or benefit changes requested. Notice must be in writing.
The Voluntary Benefits Plan P.O. Box 12009 Cheshire, CT 06410
Phone: 1-800-422-4492 Fax: 1-203-754-7847
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 One World Financial Center, 200 Liberty Street, New York, NY 10281. 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. G-224,540, 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.