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 Plus 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 also coverage for Major Dental Services.
D. Waiting Periods, Deductibles and 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. For Major Dental Services there is a 180-day waiting period. After the waiting period, payments are 50% of the per-service benefit for the remainder of the first policy year. After the first year, payments are 100% of the per-service benefit. (The 180-day waiting period applies in all states where Dental coverage is available except Kansas).
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 $1500 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 list of covered services
- Procedures before the effective date, after the termination date of coverage, or in excess of the maximum calendar year benefit
- Any procedure performed by an immediate family member or a person other than a dentist or dental hygienist or, in Idaho, a denturist
- Any service that is not required for the preservation or restoration of oral health
- Experimental or investigative services
- Preventive services performed within 150 days of previously submitted preventive services
- Repairs to dental work within 180 days of the initial procedure
- Replacement prosthetics, crowns, inlays or onlays within five years of the previous placement
- Dental implants or the removal of implants
- Cosmetic services, unless performed to correct a functional disorder
- Orthodontic treatment and services
- Services performed outside the United States, its territories and Canada, except for emergency dental treatment
- Replacement of any tooth missing prior to the effective date
- Placement of full or partial dentures, including a Maryland Bridge, unless replacing a functioning natural tooth extracted while you were covered
- Inlays, onlays, bridgework or crowns for those under age 16, except for stainless steel or plastic crowns
- Any procedure or treatment required due to:
- War or any act of war
- Participation in the military service of any country or international organization
- Attempted suicide or self-inflicted sickness or injury
- Taking part in a riot or insurrection
- Participating in an illegal occupation or activity
- Voluntary use of any controlled substance, except when taken as instructed by a physician
- Riding in any aircraft not licensed to carry passengers or not operated by a duly licensed pilot
- Operating a motor vehicle while your blood alcohol level was over the legal limit
This brochure provides a summary of benefits, limitations and exclusions. In certain states, an outline of coverage is available from the agent or the insurer. Please refer to the outline of coverage for a description of the important features of the Dental Plus plan. Please read the coverage documents carefully for a complete listing of benefits, limitations and exclusions.
THIS POLICY IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available at www.medicare.gov/Publications/Pubs/pdf/02110.pdf.
Coverage is renewable provided you have not moved to a state where we do not offer this plan or no longer qualify as a dependent. Time Insurance Company has the right to change premium rates upon providing appropriate notice.
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.