Plan Information for Perfect Smile
A. Enrollment and Eligibility
Individuals who are between 18 and 65 years of age and their eligible dependents. Eligible ages for dependents may vary by state. Click here for a sample and brief description of eligible ages of dependents by state. For specific information, please contact us.
B. Your Effective Date
Policy effective dates are always the FIRST of the month. If the enrollment form and payment information are received by DentalInsurance.com by the 20th of the month, coverage will become effective on the FIRST of the following month. Incomplete enrollment forms, or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Policy until you receive your certificate of insurance.
C. How does the plan work?
This dental insurance plan is designed for members of the National Consumer's Advantage Association and their eligible family members. The association dues of $1 will be drafted from your account along with the premium for the plan. As an association member, you will have access to the many benefits of this plan. For further information regarding the association, please call 1-800-992-8044. This plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges, and dentures.
D. Annual Deductible & Calendar Year Maximums
The annual deductible is the amount of covered dental charges incurred by an insured person or on behalf of your insured dependent before American National Life Insurance Company of Texas starts paying benefits. The annual deductible of $50 will apply to each insured person. The Calendar Year Maximum is the maximum amount payable for all eligible dental expenses in any calendar year as shown on the Benefit Schedule. The Calendar Year Maximum will apply to each insured person.
E. Benefit Waiting Period
The period of time a Covered Person must be covered under the Certificate after his or her Effective Date of coverage before benefits are eligible.
F. Choice of Provider
This plan is an indemnity plan that allows you to choose to obtain services from any licensed dentist of your choice.
G. Specialty Care/Specialist Referrals
Specialty Care can be utilized and the benefits will be applied based on the type of service needed, provided the waiting periods have been satisfied.
H. Emergency Dental Services
Emergency services can be utilized and the benefits will be applied based on the type of service needed, provided the waiting periods have been satisfied.
I. Coordination of Benefits
American National Life Insurance Company of Texas coordinates the benefits under this Certificate with a Covered Person’s benefits under any other group pre-paid program or insurance policy. Benefits under one of the programs may be reduced so that combined coverage does not exceed the Dentist’s total fees for covered services. If this Certificate is the “primary” program, American National Life Insurance Company of Texas will not reduce Benefits. But if the other program is the primary one, American National Life Insurance Company of Texas will reduce benefits otherwise payable under this Certificate. The reduction will be the amount paid for or provided under the terms of the primary program for covered services under this Certificate.
J. Exclusions/Limitations (may vary by State)
Benefits will not be paid for dental expenses arising from or in connection with:
- Treatment, services or supplies which:
- Are not Medically Necessary;
- Are not prescribed by a Dentist;
- Are determined to be Experimental/Investigational in nature by Us;
- Are received without charge or legal obligation to pay;
- Would not routinely be paid in the absence of insurance;
- Are received from any Family Member.
- Intentionally selfinflicted injuries.
- War or an act of war, whether or not declared.
- A Covered Person's commission of a felony.
- Participation in a riot.
- Employment, whether caused by, related to, or as a condition of, including selfemployment. This exclusion applies even if Workers' Compensation or any Occupational Disease or similar law does not cover the charges.
- Treatment which began, before the Covered Person's Effective Date of coverage or after the Covered Person's termination of coverage.
- Congenital or development malformations existing when the Covered Person's coverage began effective under this Certificate.
- Cosmetic procedures.
- Surgical implants or transplants of any type including prosthetic devices attached to them.
- Temporomandibular joint syndrome.
- Periodontal splinting.
- Facings on crowns, or pontics posterior to the 2nd bicuspid.
- Replacement of partial or full dentures, fixed bridge work, crowns, gold restorations and jackets more often than once in any 5 year period.
- Relining of dentures more often than once in any 2 year period.
- Lost, stolen, or missing dentures or bridges or for duplicates.
- Fixed or removable bridgework involving replacement of a natural tooth or teeth which was lost prior to the Covered Person's Effective Date of coverage under this Certificate. Benefits may be payable for bridgework required for loss of teeth while covered under this Certificate, if such bridgework is not an abutment for noncovered bridgework.
- Prescription Drugs and analgesia premedication.
- Charges for telephone consultations, failure to keep a scheduled appointment, to complete claim forms or attending Dentist statements, and any other services or supplies which are not part of the direct treatment of the Covered Person.
- Dental education or training programs including oral hygiene or plaque control programs.
- Counseling on diet and nutrition.
- Expense related to a Covered Person's military service, including service in a military reserve unit.
- Orthodontia, unless this coverage is elected by the Policyholder and the required premium is paid.
- Prosthodontics, unless this coverage is elected by the Policyholder and the required premium is paid.
- Charges payable under any medical insurance.
- Charges made by any government entity unless the Covered Person is required to pay.
- Use of materials, other than fluorides or sealants, to prevent tooth decay.
- Bite registrations.
- Bacteriologic cultures in connection with a covered dental service.
- Therapeutic injections administered by a Dentist.
This is a general summary of the features of the American National Life Insurance Company of Texas plan. When you purchase the policy you will receive a Certificate of Insurance that details your rights and obligations, as well as those of the insurance company.
This website provides a very brief description of some of the important features of this policy. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exceptions and limitations is contained in the Certificate of Insurance. Policy Form Series DENT06.