A. Enrollment and Eligibility
Coverage is offered to you, and your dependents. Apply through age 64.
- The Policyholder’s lawful spouse, including the Policyholder’s Domestic Partner (state requirements defining domestic partnership should be met)
- The Policyholder’s naturally born child, legally adopted child, a child that is placed for adoption with the Policyholder, a stepchild, including children of Domestic Partner, or a child for whom the Policyholder is the legal guardian:
If Your unmarried child is age 19 or older, the child will be considered a Dependent if You give Us proof that:
- Who is unmarried; and
- Who is age 18 or younger; and
- Who is claimed as an exemption on Your most recent federal income tax return, except for a Dependent child who is a full-time student.
- the child is under age 25 and a full-time student at an accredited educational institution, college or university.
- The child is not capable of self-sustaining employment or engaging in the normal and customary activities of a person of the same age because of mental incapacity or physical handicap.
You may elect to be covered under this plan by completing the enrollment process and submitting any required premium. You must be a resident of the state where this plan is issued.
*Please Note: If your prior policy has not been termed for at least 12 months, you will not be eligible for a new dental policy with Time Insurance Company until the 12 months have elapsed.
B. Your Effective Date
The effective date will be the later of:
- The day after the application is signed or the day after an electronic application is submitted; backdating is not permitted.
- The future date that the applicant requests; however, no policy will be dated on the 29th, 30th or 31st of any month. Applications completed on these dates should have a requested effective date of no earlier than the first of the following month.
C. How does the Time Insurance Company Intermediate plan work?
You have the freedom to see any dentist of your choice - no network restrictions. You'll receive a fixed cash benefit for each covered service. You will be responsible for any additional costs not paid by the plan. A complete list of benefits will be provided with your policy details. There is no coverage for Major Dental Services.
D. Calendar Year Maximums
There is no deductible on this plan, but for Basic Dental Services, benefits will be paid at 50% for any covered procedure during the first year of the policy. In the second year of coverage, you will receive 100% of the benefit.
The Calendar Year Maximum is the maximum amount payable for all eligible dental expenses in any calendar year as shown on the Fee Schedule. The calendar-year benefit maximum for this plan is $1000 per member, excluding your preventive services.
E. Choice of Provider
You have the freedom to see any dentist of your choice - no network restrictions.
F. Emergency Dental Services
Emergency Dental Treatment – any Dentally Necessary service, procedure, or supply which is rendered as the direct result of unforeseen events or circumstances which require prompt attention. We pay only for Dental Treatment, according to the classifications and subject to the benefit amounts provided on the Policy Schedule, when Dentally Necessary and provided by a Dentist or Dental Hygienist licensed to perform such procedure or treatment.
G. Coordination of Benefits
Plan pays in addition to any other dental plan you may have.
H. Cancellation Policy
The Policyholder may cancel this coverage at any time by sending written notice or calling our office. Upon cancellation, we will return the unearned portion of any premium paid, in accordance with the laws in the Policyholder’s state of residence.
I. Exclusions and Limitations
This Policy pays limited, fixed indemnity benefits for Dental Treatments only. See the Policy Schedule for the limited benefit amounts and maximum benefit limitations.
We will not pay benefits for any of the following:
- any procedure or treatment not shown on the Policy Schedule.
- any procedure rendered during an applicable Benefit Waiting Period.
- any amount in excess of a Calendar Year or lifetime maximum benefit limitation.
- Dental Preventive Benefits when there is less than 150 calendar days between the dates of service for Dental Preventive Services.
- all Experimental or Investigative Services.
- any procedure performed by a person other than a Dentist or Dental Hygienist.
- any procedure performed by a Covered Person’s Immediate Family Member.
- all services that are not Dentally Necessary.
- repairs to dental work less than 180 calendar days following completion of the initial procedure.
- prosthetics replaced less than 5 years following the previous placement.
- crowns replaced less than 5 years following the previous placement.
- inlays or onlays replaced less than 5 years following the last placement.
- dental implants or the removal of implants.
- Cosmetic Services.
- services performed outside the United States and, its territories and Canada except for services that are received for Emergency Dental Treatment.
- replacement of any tooth missing prior to the Effective Date.
- placement of full or partial dentures, whether removable or fixed, including a Maryland Bridge, unless replacing a Functioning Natural Tooth extracted after the Effective Date and not within a Benefit Waiting Period.
- for Covered Persons under age 16, inlays, onlays, bridgework or crowns except for stainless steel or plastic crowns.
- any charge or procedure for treatment required because of Dental Injury or disease due to:
- war or any act of war, whether declared or undeclared.
- participation in the military service of any country or international organization, including non-military units supporting such forces.
- charges for Sickness or Injury caused or aggravated by attempted suicide or selfinflicted Sickness or Injury, even if the Covered Person did not intend to cause the harm which resulted from the action which led to the self-inflicted Sickness or Injury.
- taking part in a riot or insurrection, or an act of riot or insurrection.
- participating in, voluntarily attempting to commit or commission of a felony, whether or not charged, or engaging in an illegal occupation or activity at the time of an Accident.
- riding in any aircraft not licensed to carry passengers or not operated by a duly licensed pilot.
- procedures rendered before the Effective Date or after the termination date of coverage.
- orthodontic treatment and services.
J. Grievance Procedures
Policyholders can appeal their claim. A claim review process is outlined in the Explanation of Benefits (EOB) and may be different based on the State you are residing in. A review must be requested in writing within 180 days following Your receipt of the notice that the claim was denied or reduced. For details, please refer to your Dental Policy Packet.