A. Enrollment and Eligibility
Coverage is available for individuals age 19+. 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.
o 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?
The plan pays a flat dollar amount per dental procedure based on the fee schedule in the policy. We will pay the lesser of the provider’s actual charge or the amount listed on the Schedule of Covered Dental Procedures, subject to policy year deductible, annual maximum, and limitations and exclusions.
D. Annual Deductible & Calendar Year Maximums
There is a $50 annual deductible per person ($150 maximum per family) and a $1,000 per person per benefit year maximum. The annual deductible does not apply to preventive services.
E. Choice of Provider
Members may choose any dental provider or visit an in-network provider and pay even less. Our dental network consists of over 180,000 access points nationally for your convenience.
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 by 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.
- The policy does not cover losses caused by or resulting from any of the following. 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 Procedures or the Policy Schedule.
- Amounts in excess of the Policy Year Benefit Maximum.
- Services or supplies we consider being experimental or investigative.
- Any injury or illness when covered under Worker’s Compensation or similar law, or which is work related.
- Services received before a Covered Person’s effective date, including started but not completed services.
- Services received after, or started but not completed within 30 days of a Covered Person’s coverage ending.
- Charges for dental services performed by 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 prosthetics within seven years of last placement.
- Treatment involving crowns for a given tooth within seven years of last placement, regardless of the type of crown.
- Replacement for inlays or onlays for a given tooth within seven years of last placement.
- Any services performed for convenience or cosmetic purposes.
- Any charge for a service required as a result of disease or injury that is due to war or an act of war (whether declared or undeclared); taking part in an insurrection or riot.
- ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation.
- Services performed by a Dentist who is a member of the covered person’s Immediate Family.
- 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 the 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 the policy.
- Federal, State or local taxes are not included as part of a Covered Dental Expense.
- See the Schedule of Covered Dental Procedures in the policy for all specific procedure limitations.
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 1-888-729-5433, Ext. 2013.
This is a brief description of the individual dental plan. A full explanation of benefits, limitations and exclusions is contained in the policy issued when coverage becomes effective. Policy Form Series IDN-2009. Underwritten and administered by Starmount Life Insurance Company.
*Subject to policy deductible, annual maximum and limitations and exclusions. Waiting periods do not apply in Washington.