Coverage includes dental and vision benefits for one low cost, through payroll deduction. In order for you to utilize the benefits of the Prepaid 225 with Ortho Co-payments Plan, you must select a dentist from the list of Participating General Dentists for you and your family. Click on the following links for more information and benefits of the Prepaid 225 with Ortho Co-payments Plan. This plan is underwritten by Union Security Insurance Company.
- no charge services
- routine cleanings
- fluoride treatments
- may select a general dentist for each family member
- other services at predetermined co-payments
- implant benefit
- orthodontic co-payments for adults and children
- specialty care available at a 15% to 25% discount of participating specialists’ normal fees
- other plan benefits
- no deductibles
- no claims forms
- no annual dollar maximum
- all preexisting dental conditions are covered
- No waiting periods
Provider search allows dental plan members to easily locate participating network dentists and vision providers.
Limitations and exclusions apply with respect to the Member’s oral conditions without regard to whether or not such conditions existed before the effective date of the Member’s enrollment.
Limitations and exclusionsExclusions 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
Extractions by a Plan Provider for solely orthodontic purposes are not subject to the fixed Co-payments shown for extractions in the Co-payment Schedule. Instead, such extractions are subject to charges reflecting a 25% reduction from that Plan Provider’s normal retail charges for such extractions.
The Member’s enrollment may be terminated as stated in the TERMINATION article of the Evidence of Coverage.
- 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.
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.
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SLPC 29218 8/18 (exp. 8/19)