Increasing Max 2.0+Vision
A. Enrollment and Eligibility
Coverage is available for individuals age 18+. Separate rates apply for individuals 65+ who apply for coverage. You may elect individual only, individual + spouse, individual + children or individual + family coverage. Dependent eligibility may vary by state, please click here to view the State Eligibility Requirements.
B. Your Effective Date
The coverage start date is the 1st of the month and is determined by the date the completed application is received subject to the initial premium being paid. If the initial premium is not successfully processed, you will be notified and coverage will not be put in force.
If the application is received on or before the 25th of the month, coverage will start on the 1st of the next month. For example, if we receive the application on November 15th coverage will be effective December 1st. If the application is received after the 25th of the month, coverage will start on the 1st of the following month. For example, if we receive the application on November 26th coverage will be effective January 1st.
C. How does the Individual Dental plan work?
This is PPO plan. This plan rewards your loyalty by increasing your annual maximum from $1,000 per covered person in year one, up to $1,500 per person in year three. Members further reduce out-of-pocket costs for any services through our national network of 323,000+ dentist access points. Services not covered by your plan may still be eligible for in-network discounts from providers who offer discounts.
D. Annual Deductible & Calendar Year Maximums
There is a $50 annual deductible per person ($150 maximum per family) for Basic and Major Services Only, and benefit year maximum of $1,000 per person in year one, up to $1,500 per person in year three.
E. What does the vision plan include?
The vision plan is a fully insured plan that provides coverage for a comprehensive eye exam and materials purchases once per 12 months. There are low co-pays for your exam and materials with generous in-network allowances for the purchase of frames or contact lenses. Frames are covered up to the retail allowance and you may choose any frame available. In lieu of frames and lenses, you may use the available retail allowance to purchase contact lenses that include your fit, follow-up and materials.
F. Coordination of Benefits
Yes, we do coordinate benefits. The policy that has been in-force the longest period of time will be considered the primary policy. We will request EOB’s from the primary carrier to determine the paid amount and any remaining balance will be paid up to our scheduled amount listed in the policy. We will not exceed the lesser of the scheduled amount or the billed amount.
G. Cancellation Policy
Request for cancellation may be submitted by emailing email@example.com, calling Customer Service or mailing your request to 8485 Goodwood Boulevard, Baton Rouge, LA 70806. The effective date of termination will be the last day of the month for which premium is paid.
H. Termination of Policy
Coverage terminates on the earliest of the following dates:
- the last day of the month in which you cease to be eligible for coverage;
- the last day of the month in which your dependent is no longer a dependent as defined in the policy
- subject to the grace period, the last day of the month for which a premium has been paid by you or on your behalf.
- or the date the policy ends.
- No benefits are payable under this Policy for the procedures and services listed below unless such procedure or service is listed as covered in the Schedule of Covered Dental Procedures. In addition, the procedures listed below will not be recognized toward satisfaction of any Policy Year Deductible.
- Any procedure or service not shown on the Schedule of Covered Dental Procedures.
- Amounts in excess of the Policy Year Benefit Maximum.
- Any procedure We determine which is not necessary, does not offer a favorable prognosis, or does not have uniform professional endorsement or which is experimental in nature.
- Any injury or illness when covered under Worker’s Compensation or similar law, or which is work related.
- Any procedure or appliance installed before an Insured’s effective date, including started but not completed services.
- Any procedure begun after an Insured’s insurance under the Policy terminates, or for any prosthetic dental appliance finally installed or delivered after an Insured’s insurance under the Policy terminates.
- Charges for dental services performed by anyone other than a licensed dentist or dental hygienist.
- Services that are not recommended by a dentist or that are not required for the preservation or restoration of oral health.
- Repairs or adjustments to dental work within six months of the initial work.
- Replacement of full or partial dentures unless the prosthetic appliance is older than the age allowed in the Schedule of Covered Dental Procedures and cannot be made serviceable.
- Treatment involving crowns for a given tooth within seven years of last placement, regardless of the type of crown.
- Replacement of implants, crowns, inlays or onlays unless the prior restoration is older than the age allowed in the Schedule of Covered Dental Procedures and cannot be made serviceable.
- Any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior cosmetic restorations.
- Service or appliance rendered by someone who is related to an Insured by blood or by law (e.g., sibling, parent, grandparent, child), marriage (e.g., spouse or in-law) or adoption or is normally a member of the Insured’s household.
- The correction of congenital malformations or congenital missing teeth.
- The replacement of lost or discarded or stolen appliances.
- Replacement of bridges unless the bridge is older than the age allowed in the Schedule of Covered Dental Procedures and cannot be made serviceable.
- Appliances, services or procedures relating to: (a) the change or maintenance of vertical dimension; (b) restoration of occlusion (unless otherwise noted in the Schedule of Covered Dental Procedures—only for occlusal guards); (c) splinting; (d) correction of attrition, abrasion, erosion or abfraction; (e) bite registration or (f) bite analysis or (g) bruxism.
- Services provided for any type of temporomandibular joint (TMJ) dysfunctions, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain.
- Orthognathic surgery.
- Prescribed medications, premedication or analgesia.
- Any instruction for diet, plaque control and oral hygiene.
- Charges for: implants of any type (except those implants specified in the Schedule of Covered Dental Procedures), and all related procedures, removal of implants, precision or semi-precision attachments, denture duplication, overdentures and any associated surgery, or other customized services or attachments.
- Cast restorations, inlays, onlays and crowns for teeth that are not broken down by extensive decay or accidental injury or for teeth that can be restored by other means (such as an amalgam or composite filling).
- For treatment of malignancies, cysts and neoplasms.
- For orthodontic treatment except those services or treatments provided in the Schedule of Covered Dental Procedures.
- Charges for failure to keep a scheduled visit or for the completion of any Claim forms.
- Expenses provided or paid for by any governmental program or law, except as to charges which the person is legally obligated to pay or as addressed later under the “Payment of Claims” provision.
- Procedures started but not completed.
- Any duplicate device or appliance.
- General anesthesia and intravenous sedation except in conjunction with covered complex oral surgery procedures as defined by Us, plus the services of anesthetists or anesthesiologists.
- The replacement of 3rd molars.
- Crowns, inlays and onlays used to restore teeth with micro fractures or fracture lines, undermined cusps, or existing large restorations without overt pathology.
- No benefits will be paid for replacement of teeth missing prior to the effective date of coverage.
- No benefits will be paid for the initial placement of removable full or partial dentures, unless it includes the replacement of a Functioning Natural Tooth extracted while the covered person is insured under this policy.
- No benefits will be paid for the initial placement of a fixed partial denture including a Maryland Bridge, unless it includes the replacement of a Functioning Natural Tooth extracted while the covered person is insured under this policy.
- Other Limitations: Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. Coverage is limited to two prophylaxis and/or two periodontal maintenance procedures, subject to a maximum total of no more than two (2) procedures per twelve (12) month period. Coverage is limited to one (1) full mouth radiograph or panoramic film per limitation period listed in the Schedule of Covered procedures. On any given day, more than seven (7) periapical x-rays or a panoramic film in conjunction with bitewings will be paid as a full mouth radiograph. Additional limitations are noted in the Schedule of Covered Dental Procedures.
- Federal, State or local taxes are not included as part of a Covered Dental Expense.
J. Grievance Procedures
If you or one of your eligible dependents has a complaint with Starmount Life Insurance or your dentist, you may register a Complaint by calling Customer Service at (888) 729-5433, Ext. 2013.
Underwritten and administered by Starmount Life Insurance Company. Please Note: A full listing of covered procedures will be provided with your policy. This website is not a contract of insurance. This is a brief description of the plan and should be used only as a guide. It does not contain complete plan details. Terms and conditions, including a complete list of benefits, limitations and exclusions, are defined in the policy issued following enrollment in the plan. If questions arise concerning coverage, the policy will govern. Not available in all states. Rates and benefits may vary by state. Policy form series IDN2016P.