Insured Plan

Indemnity PPO plan

(People First Plan Code: 4074)

The Freedom Advance Insured Plan provides you with a choice of any dentist or specialist you choose. By seeing an Assurant® Dental Network¹ dentist, you will receive discounts off their usual fees by approximately 30% which can save you money. To locate a participating dentist in your area, visit PPO Dental Provider to complete the search. Claim forms must be filed, and certain limitations and exclusions apply. Coverage includes dental and vision benefits for one low cost, through payroll deduction. This plan is underwritten by Union Security Insurance Company.

This page includes a brief summary of the Freedom Advance insured plan benefits. A complete description of insured benefits, including limitations and exclusions, will be provided in the Certificate of Insurance.

2018 Certificate of Insurance
2019 Certificate of Insurance

Lifetime of Smiles program features:

  • 4 periodontal cleanings per year
  • White fillings on back teeth
  • Brush biopsies for early cancer detection
  • Testing for genetic gum disease
  • Coverage for antimicrobial agents
  • Discounts on dental healthcare products
Type I preventive dental services, including:
  • routine oral exams
  • routine dental cleanings
  • fluoride treatment (children under 14)
  • sealants (children under 16)
  • space maintainers (children under 16)
  • harmful habit appliance (children under 16)
  • bitewing x-rays
Type II basic dental services, including:
  • x-rays:
    • complete series
    • panoramic
    • other x-rays (see certificate of insurance)
  • new fillings: replacement fillings
  • simple extractions, removal of exposed roots, incision and drainage
  • certain lab tests, pain treatment, therapeutic drug injections
  • endodontics (Root Canals)
  • endodontic treatment (Root Canal Treatment)
Type III major dental services, including:
  • complex oral surgery
  • minor gum disease treatment
    • provisional splinting, occlusal adjustments
    • scaling and root planing
    • periodontal maintenance
  • major gum disease treatment
    • gingivectomy, osseous surgery, other major periodontic procedures
  • initial placement, replacement and maintenance of inlays, onlays, crowns, fixed partial dentures (bridges), and partial and complete dentures
Type IV orthodontic dental services (only for dependent children under age 19)
  • limited orthodontic treatment
  • interceptive orthodontic treatment
  • comprehensive orthodontic treatment
  • minor treatment to control harmful habits
Payroll deduction Bi-Weekly Monthly
Employee $21.78 $43.55
Employee/Spouse $45.29 $83.61
Employee/Child(ren) $49.42 $98.83
Employee/Family $65.18 $130.35


Freedom Advance
Coinsurance Percentage
In Network Out-of-Network
Type 1 100% 100%
Type 2 80% 80%
Type 3 50%
50%
Calendar year maximum $1,250
Calendar year deductible $50 per person/$100 per family (applies to type 2 and 3 services only)
Type 4 50% 50%
Lifetime maximum $1,500

Provider search

Provider search allows dental plan members to easily locate participating network dentists and vision providers.

Limitations and exclusions

Exclusions may prevent expenses from being covered based on certain circumstances. The following expenses may not be covered:
  • Procedures not performed by a licensed dentist
  • Procedures not listed as covered dental expenses
  • Dental care for injuries that are work related, self-inflicted, or not caused by an accident
  • Orthognathic surgery
  • Dental care resulting from active participation in a riot or commission of a felony
  • Experimental treatment, oral hygiene, plaque control programs, and dietary instruction
  • Dental care for injuries sustained as a result of war or act of war
  • Charges for pulp caps
  • Dental expenses incurred while coverage is not in force
  • Charges for care, treatment, services, or supplies to the extent that any benefit is provided by Medicare
  • Charges not customarily made when there is no insurance or charges for which there is no legal obligation to pay
  • Charges for failure to keep appointments
  • Replacement or repair of a lost, stolen, or damaged prosthetic or orthodontic appliance
  • Additional services, such as orthodontia and/or surgical implants, are not covered unless specifically listed under covered services. Also not covered are charges for diagnostic services and treatment of jaw joint problems, such as temporomandibular joint disorders, by any method unless specifically covered under the Certificate

Resources

  • Online Advantage - As a member, you have access to view your plan information, claim status and more through Online Advantage. Register today to access your benefits online!
  • Dental Health Center - As a member, you have access to a wide range of information about dental health care and how it relates to your general health and preventive wellness.
  • Dental Health Facts - Did you know that more than 75% of American adults suffer from various forms of gum disease and don’t even know it?
  • People First Service Center - To enroll for your dental plan, please call People First at 866-663-4735 or enroll online.

Contact Information

New hire and enrollment questions? Call our agent State Securities Corp
Toll Free: 800-277-2300
Telephone: 850-386-2300
Existing plan member questions?
Prepaid: 800-443-2995
To submit a claim, mail to:
Sun Life Financial
P.O. Box 2940
Clinton, IA, 52733-29400
Email questions or comments to:

1. Assurant Employee Benefits”, the Assurant name, and related logos are trademarks of Assurant, Inc. and are used under license.

Insurance products are underwritten by Union Security Insurance Company (USIC) (Kansas City, MO) under Form Series GP-12/GC-12, and administered by Sun Life Assurance Company of Canada (SLOC) (Wellesley Hills, MA). Prepaid dental products are provided by USIC under Form Series BDC-GDSA and are administered by SLOC.

FLORIDA USE ONLY

© 2018 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

SLPC 29218 8/18 (exp. 8/19)