A. Enrollment and Eligibility
Individuals who are 18 or old and their eligible dependents (unmarried children from birth to age 19; extended to age 26 if the child is a full-time student).
B. Your Effective Date
Plan effective dates are always the FIRST of the month. If the enrollment form and payment information are received by DentalInsurance.com by the 25th 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 Plan until you receive your certificate of insurance.
C. How does the Master plan work?
As long as you meet the plan's general eligibility requirements and pay the applicable premium, your acceptance is automatic. This Plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges, and dentures. Alternate Benefit: Vision Discount
D. Annual Deductible & Calendar Year Maximums
There are no deductibles and no annual maximums.
E. Choice of Provider
The Master Plan is a dental plan that allows you to choose to obtain services from any licensed dentist of your choice within the network.
F. Specialty Care/Specialist Referrals
Specialty care partners offer plan members a 25% discount from their Usual and Customary fees for our SmileCard and Master Plans.
G. Emergency Dental Services
Emergency services can be utilized and the benefits will be applied based on the type of service needed.
If you have a dental emergency, please contact your Argus General Dentist or our Customer Care Department immediately. Argus offers a $50 per claim/$100 per year benefit to assist members who require emergency care while temporarily traveling outside of the State of Florida. Please see your Certificate of Coverage for details.
H. Cancellation/Termination of Policy
- Subscriber’s coverage will cease and terminate upon the occurrence of any of the following events:
- The end of the period for which required Premiums are due but not paid;
- The date that a Dependent no longer satisfies the definition of Dependent contained herein;
- Subscriber leaves the geographical service area of Plan with the intent to relocate or establish a new residence on a permanent basis outside of Plans geographical area;
- Voluntary termination. (Premium not refundable)
- In addition, if after forty-five (45) days written notice of cancellation, coverage will terminate:
- After reasonable efforts have been made by all parties to establish a working dentist/patient relationship and have been unsuccessful;
- Because of fraud, material misrepresentation, misuse of dental services, facilities or membership privileges;
- Because of misuse of documents provided as evidence of coverage available to Subscriber through Plan;
- Upon Subscriber furnishing to Plan, by Subscriber, incorrect or incomplete information for the purpose of fraudulently obtaining services.
- This is a one (1) year policy.
Termination request must be submitted in writing 30 days prior to end of contract. Contract will renew automatically if notification is not submitted.
- Services which, in the opinion of the participating General Dentist or Specialist, are not necessary for the patient's dental health.
- Cost of hospitalization, pharmaceuticals and general anesthesia.
- Any services performed by a non-participating General Dentist or non-participating Specialist.
- Services that cannot be performed because of the general health of the patient.
- Treatment which, in the opinion of the participating General Dentist, must be performed by a non-participating Specialist.
- Services which are not consistent with the usual and customary services provided by the Participating General Dentist or Specialist.
- Any dental treatment started prior to the member's effective date.
- Services for injuries and/or conditions that are paid by Workers' Compensation or Employers' Liability Laws.
- Treatment for cysts, neoplasms and malignancies.
J. Grievance Procedures
If you or one of your eligible dependents has a complaint you may issue a Complaint by calling Argus Dental’s Member Services.
This is a general summary of the features of the Master Plan. When you purchase the plan 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 plan. 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.