MAX Choice Plus
A. Enrollment and Eligibility
You may enroll yourself and your eligible dependents. Dependents named in the application must be approved by Renaissance Dental as eligible. Specific criteria for dependent eligibility may vary by state.
B. Your Effective Date
Plan effective dates are always the 1st of the month. If the enrollment form and payment information are received by the 19th of the month, coverage will become effective on the 1st 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. Annual Deductible and Calendar Year Maximums
Renaissance Dental MAX Choice PLUS plan has a $1,000 first year annual maximum that escalates to $3,000 in the third year (per person per year); $50 per person/$150 per family deductible for Basic and Major Services Only (The Deductible does not apply for Diagnostic and Preventive or Orthodontic Services); and $1200 Orthodontic Lifetime Maximum per person up to age 19.
D. Waiting Periods
No waiting periods on any covered services.
E. Choice of Provider
Access to over 200,000 nationally credentialed dental PPO provider access points. With MAX Choice Plus plan individuals may visit any dentist, but will receive the best benefits by seeing a dentist who participates in the Renaissance PPO network. MAX Choice Plus gives you more value if you visit an out-of-network dentist by paying claims at a higher level of reimbursement than our MAX Choice (PPO MAC) plan option.
F. Emergency Dental Service
If you have a dental emergency, contact your current dentist for an emergency appointment. If he or she is unable to see you, please contact Customer Service at (888) 791-5995 for specific emergency benefit information and procedures.
G. Cancellation Policy
Your coverage may be cancelled with a 30-day notice. All cancellations require a 30-day notice via email to firstname.lastname@example.org or by fax to (601) 956-3795. You may also contact Morgan White Group customer service at 1-866-569-8654 to process the request. You can also cancel your coverage by logging onto your client portal at my.mwadmin.com.
H. Termination Policy
- All insurance will cease on termination of the Policy. This Policy will terminate on:
- Nonpayment of premiums when due, subject to the Grace Period Provisions; or
- The date Renaissance Dental receives a written request from you to terminate the Policy, or any later date stated in your request; or
- The date Renaissance Dental declines to renew the Policy as provided by the above renewal clause; or
- The date of your death, if this Policy is an Individual Plan.
Morgan White Group will refund any premium paid and not earned due to Policy termination. The refund will be based on the number of full months that remain in the premium period. If this Policy is other than an Individual Plan, it may be continued after your death: (a) by your spouse, if an Eligible Dependent; otherwise, (b) by the youngest Child who is an Eligible Dependent (if Children are covered under this Policy). The Policy will be changed to a plan appropriate, as determined by us, to the Eligible Dependents that continue to be covered under it. Your spouse, or youngest Child, will replace you as the Insured. A proper adjustment will be made in the premium required for the Policy to be continued. Morgan White Group will also refund any premium paid and not earned due to the Insured’s death. The refund will be based on the number of full months that remain to the next premium due date.
- No pre-existing condition exclusions or limitations.
- Oral exams, prophylaxes (cleanings), and fluoride treatments (up to age 14) are payable twice per calendar year.
- People with specific at-risk health conditions may be eligible for additional prophylaxes or fluoride treatment. The patient should talk with his or her dentist about treatment.
- Bitewing X-rays are payable once per calendar year and full mouth X-rays are payable once in any five-year period.
- Sealants are payable only for the occlusal surface of first permanent molars to age nine and second permanent molars to age 14.The surface must be free from decay and restorations. Sealants are payable once per tooth per 36 months.
- Crowns, bridges, dentures and implants are payable once per tooth per five-year period.
Billing and eligibility administration provided by Morgan-White Administrators, Inc.
Renaissance Life & Health Insurance Company of America P.O. Box 1596 Indianapolis, IN 46206
and in New York by:
Renaissance Health Insurance Company of New York, New York, NY.