Preferred 45
Plan Information

Dental Insurance Plan Information

A. Enrollment and Eligibility
Individuals 18+, plus their eligible dependents. This is subject to individual state regulations.

B. Your Effective Date
For a 1st of the month effective date, apply by the 10th of that same 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.
Please Note: Enrollments received up to the last date of the month and up until the 10th day of the next month may result in being billed for the first two months premium.

C. How does the Security Life plan work?
As long as you meet the plan's general eligibility requirements and pay the applicable premium, your acceptance is automatic. This plan contains waiting periods that must be satisfied before coverage is available for services. This Plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges, and dentures.

Eligible Expenses:
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 or procedure must be performed by:

  • a Dentist
  • a Dental Assistant; or
  • a Dental Hygienist.

Expenses Incurred:
An eligible expense is considered incurred on the following dates:

  1. For dentures the date the final impression is taken.
  2. For fixed bridges, crowns, inlays and onlays - the date the teeth are first prepared.
  3. For root canal therapy - the date the pulp chamber is opened.
  4. For periodontal surgery - the date surgery is performed.
  5. For all other services - the date the service is performed.

Predetermination of Benefits: It is recommended that a treatment plan/course of treatment be submitted when the total cost of eligible expenses for any insured is expected to exceed the amount shown on the coverage schedule. This should be submitted to us before the work is started. If actual services submitted do not agree with the treatment plan, or if a treatment plan is not sent in, we will base our payment on treatment consistent with reasonable and customary charges. Predetermination of benefits is not a guarantee of what we will pay. The estimated benefit payment is based on your current eligibility and benefits in effect at the time of the completed service. Submission of other claims or changes in eligibility or this policy may alter final payment.

Alternate Benefit: If Security Life determines that a less expensive alternate procedure, service or course of treatment can be performed in place of the proposed treatment to correct a dental condition; and the alternate treatment will produce a professionally satisfactory result; then the maximum we will allow will be the charge for the less expensive treatment.

The following are not covered or available as an alternative benefit:

  • Telephone consultations, charges for failure to keep a scheduled appointment, x-ray copy fees, or charges for completion of a claim form.
  • Ancillary charges, including but not limited to, hospital, ambulatory surgical center or similar facility; or use of provider office space.
  • Charges for sterilization of equipment; disposal of medical waste or other requirements mandated by OSHA or other regulatory agencies.

D. Calendar Year Deductible & Maximum Annual Benefit
The calendar year deductible is the amount of covered dental charges incurred by an insured person or on behalf of your insured dependent before Security Life starts paying benefits. The annual deductible of $50 will apply to each insured person. The Maximum Annual Benefit is the maximum amount payable for all eligible dental expenses in any calendar year as shown on the Coverage Schedule. The Maximum Annual Benefit will apply to each insured person.

E. Choice of Provider
With this Preferred Provider Organization (PPO) plan you have the option of choosing from over 169,000 dental locations nationwide who participate in the CAREINGTON International network. These dentists must pass CAREINGTON’s rigorous credentialing process, and they agree to accept the CAREINGTON fee schedule as reimbursement in full for services. Or if you prefer, you may visit a non-CAREINGTON provider, but reimbursement will be limited to the CAREINGTON fee schedule, with any balance due being the responsibility of the member.

F. Specialty Care/Specialist Referrals
Specialty Care can be utilized and the benefits will be applied based on the type of service needed, provided the applicable, if any, waiting periods have been satisfied.

G. Emergency Dental Services
Emergency services can be utilized and the benefits will be applied based on the type of service needed, provided the applicable, if any, waiting periods have been satisfied.

H. Coordination of Benefits (for Certificates issued under Policy GH-1112)
This plan will be coordinated with any other group, blanket or franchise plan under which an individual will receive benefits. This helps keep the cost of the plan reasonable.

I. Cancellation Policy
You may cancel your policy at any time by notifying Security Life of your request in writing. However, if you voluntarily end your insurance, you will not be eligible to re-enroll for a period of 2 years after the date your coverage first ended.

J. Termination of Policy
Coverage terminates on the earliest of the following dates:

  • The last day of the month in which your dependent is no longer a dependent, as defined.
  • Subject to the grace period, the last day of the month for which a premium has been paid by you or on your behalf.
  • The date the policy ends.

K. Exclusions/Limitations
Your coverage under this policy does not cover any miscellaneous separate expense not considered a covered service or procedure.

We will not pay or provide alternate benefits for any of the following:

  1. Items, treatments or services:
    1. not listed as an eligible expense on the Coverage Schedule;
    2. not prescribed by or performed by or under the direct supervision of a dental practitioner
    3. not dentally necessary as determined by us;
    4. not meeting the accepted standards of dental practice;
    5. experimental in nature;
    6. that have a questionable prognosis;
    7. covered under any medical insurance policy; or
    8. performed by a member of your or your spouse's family (family includes parents, step-parents, in-laws, spouse or former spouse, domestic partner, children, siblings, aunts, uncles, cousins, nieces, nephews, grandparents, and guardians).
  2. Services furnished primarily for cosmetic reasons, including but not limited to:
    1. specialized techniques, characterizing and personalizing prosthetic devices;
    2. making facings on prosthetic devices for any tooth in back of the second bicuspid; or
    3. replacements of restorations performed for cosmetic reasons.
  3. Charges for any appliance or service that is used to:
    1. change vertical dimension;
    2. restore or maintain occlusion, except to the extent that this policy covers orthodontic treatment;
    3. splint or stabilize teeth for periodontal reasons; or
    4. treat disturbances of the temporomandibular joint (TMJ).
  4. Charges for any service performed as a result of abrasion, attrition, bruxism, erosion or abfraction.
  5. Space Maintainers and sealants.
  6. Occlusal or athletic mouth guards.
  7. Implantology and related services; implants and all related procedures, including removal of implants.
  8. Preventive root canal therapy.
  9. Full mouth debridement.
  10. Charges for any services that are considered to be an integral part of another service, such as pulp capping, surgical trays, or sutures.
  11. Ridge preservation, augmentation, bone grafts and regeneration procedures performed in edentulous sites.
  12. Overdentures or precision attachments.
  13. Preparation and fitting of preformed dowel or post for root canal tooth; pulp cap either directly or indirectly.
  14. Duplicate or temporary devices, appliances, and services except as listed as an eligible expense.
  15. Replacing a lost, stolen or missing appliance or prosthetic device.
  16. Application of chemotherapeutic agents.
  17. Oral hygiene, plaque control, diet instruction or infection control.
  18. Charges for sterilization of equipment; disposal of medical waste or other requirements mandated by OSHA or other regulatory agencies.
  19. Non-emergency services performed outside the United States, Canada and Mexico.
  20. Treatment which is:
    1. due to an on-the-job or job-related illness or injury; or
    2. a condition for which benefits are payable by Workers’ Compensation or similar laws, whether or not benefits are claimed.
  21. Treatment for which no charge is made or for which you are not legally obligated to pay including, but not limited to, treatment (or charges made) by:
    1. your covered employer, labor union or similar group, in its dental or medical department or clinic;
    2. a facility owned or run by any government body; or
    3. any public program, except Medicaid, paid for or sponsored by any government body.
  22. Telephone consultations, charges for failure to keep a scheduled appointment, X-ray copy fees, or charges for completion of a claim form.
  23. Codes that are by report.
  24. Ancillary charges, including but not limited to, hospital, ambulatory surgical center or similar facility; or use of provider office space.
  25. Treatment resulting from:
    1. your participation in a war or an act of war, declared or undeclared;
    2. your attempting to commit, or committing, an assault or felony;
    3. your unlawful participation in a riot, rebellion, or insurrection; or
    4. an intentionally self-inflicted injury while sane or insane.

Benefits are limited as follows:

  1. In the event you transfer from the care of one dental practitioner to that of another during the course of treatment, or if more than one dental practitioner performs services for one eligible expense, we shall be liable for not more than the amount we would have been liable for had but one dental practitioner performed the service.
  2. In all cases involving eligible expenses in which the dental practitioner and you select a more expensive course of treatment than is customarily provided by the dental profession, consistent with sound professional standards of dental practice for the eligible expense concerned, payment under the plan will be based on the charge allowed for the lesser procedure.

L. Grievance Procedures
If you or one of your eligible dependents has a complaint with Security Life Insurance Company or your dentist, you may register a Complaint by notifying Security Life at 10901 Red Circle Drive, Minnetonka, Minnesota 55343 or by calling member services at (800) 233-0307.

M. Disclaimer
This provides a very brief description of some of the important features of this insurance policy. It is not the insurance policy and does not represent it. A full explanation of benefits, exceptions and limitations is contained in the Individual Dental Policy Form IP1000 (and state specifics) or One Life Group Dental Policy that may be issued to the group trust, GH-1112 (and state specifics) or Individual Dental Policy Form IP-1000-NY. Premium rates may change upon renewal. This policy is renewable at the option of the insured (IP1000); (IP1000-NY) or the Company (GH-1112). This product may not be available in all states and is subject to individual state regulations.

Underwritten by Security Life Insurance Company of America.
10901 Red Circle Drive, Minnetonka, MN 55343.

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