Here’s How The Plan Works
The plan provides benefits for diagnostic and preventive care as well as most forms of specialty dental treatment. You may go to any dentist you wish.
The Schedule of Dental Services identifies the maximum allowable benefit you and your dependents receive when a procedure is performed. The dollar amount assigned to each procedure is the maximum you receive, not to exceed actual charges. Under this Plan, you can request to have benefits paid either directly to the dentist or you can be reimbursed for the benefit.
Members And Eligible Dependents May Enroll
You and your eligible dependents may enroll for coverage. Eligible dependents
include a lawful spouse and dependent children typically under age 21 (age 25
if a full–time student). (Subject to state variations.) All persons who were
previously insured for dental insurance under this plan and later voluntarily
ended insurance will not be eligible to re-enroll for a period of two years
following the date insurance was voluntarily ended.
Dental Plan Features
- You are GUARANTEED ACCEPTANCE
- You'll pay economical group rates
- Your benefits can be paid directly to you or the dentist
- Benefits for over 155 dental services
- No deductible for preventative procedures
- No waiting period for preventive, diagnostic, restorative (except major) or adjunctive services
- Freedom to choose any dentist you want
- The Plan is portable, it goes with you even if you change jobs
- Option to include orthodontic coverage for dependent children under age 19
Annual Maximums
You and your covered dependents are entitled to receive up to $1,200 maximum
in dental benefits each calendar year after the cash deductible is satisfied.
A lifetime maximum benefit of $850 applies to orthodontic benefits for insured
dependent under age 19.
Deductibles
The calendar year deductible is $50 per insured person, up to $150 maximum per family unit. The deductible does not apply to preventative services. It is applied against insurance–covered expenses, not billed charges.
Waiting Period
Preventive, Diagnostic, Restorative (except major) and Adjunctive Services are
provided immediately. Endodontics and Oral Surgery have a 6–month waiting period.
All other benefits have a 12–month waiting period. Once you have been enrolled
under the plan for 12 consecutive months, you are eligible for benefits under
Restorative–Major, Periodontics, Prosthetics–Removable and Fixed Bridge. For
orthodontics coverage for insured dependent children under age 19, there is
a 12–month waiting period.
Economical Plan Cost With Orthodontics
Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.
ASME Enhanced Dental Insurance Rate Chart*
Current 2009 Rates
| |
Monthly |
Quarterly |
| Member Only |
$38.67 |
$116.00 |
| Member 1 |
$68.63 |
$205.90 |
| Family |
$94.73 |
$284.20 |
Economical Plan Cost Without Orthodontics
Rates for your Insurance will not be changed unless they are changed for all insureds within your classification.
ASME Enhanced Dental Insurance Rate Chart
Current 2009 Rates
| |
Monthly |
Quarterly |
| Member Only |
$38.67 |
$116.00 |
| Member 1 |
$64.77 |
$194.30 |
| Family |
$83.62 |
$250.85 |
Payment Options
You are able to choose between two premium payment options, whichever one best suits your needs.
Option 1: Pay through Automatic Monthly Check Withdrawal (EFT Option). This saves you the time spent writing checks and remembering due dates.
Option 2: Pay through direct billing on a quarterly basis.
All billing modes except annual will include a $2.00 billing fee. To avoid
the fee, select EFT as a safe and secure payment option.
Other Important Information
Click here to view the Schedule of Dental Services
Exclusions
No benefits will be paid for expenses incurred:
- For any portion of a charge for any service in excess of the scheduled benefit
shown in the Schedule of Dental Services.
- For any procedure not listed as a scheduled benefit in the Schedule of Dental
Services.
- For overdentures and associated procedures.
- For cosmetic procedures, including charges for porcelain or other veneer
crowns, pontics and porcelain or other veneer facings on crowns or pontics
to replace molars.
- For the replacement of full and partial dentures, bridges, inlays, onlays
or crowns that can be repaired or restored to normal function.
- For implants; and for (a) the replacement of lost or stolen appliances;
(b) the replacement of orthodontic retainers; (c) athletic mouthguards; (d)
precision or semi–precision attachments; (e) denture duplication or for (f)
sealants, except as specifically provided in the Schedule of Dental Services.
- For oral hygiene instructions; and for (a) plaque control; (b) the completion
of a claim form; (c) acid etch; (d) broken appointments; (e) prescription
or take–home fluoride; or for (f) diagnostic photographs.
- For services and procedures that are begun, but not completed by the end
of the month in which coverage terminates.
- For charges in connection with an orthodontic service or procedure, except
as specifically provided by the policy.
- For charges incurred for treatment which would be given free of charge
if you were not insured.
- For charges incurred for treatment which results from a war or an act of
war.
- For care or treatment of a condition for which you are entitled to or eligible
for benefits under any Workers Compensation Act or similar law.
- For charges that are applied toward satisfaction of a deductible, if any.
- For services that are not recommended, approved and certified as necessary
and reasonable by a dentist.
- For services that are not approved by the Council of Dental Therapeutics
of the American Dental Association.
- For charges incurred for treatment which results from intentionally self–inflicted
injury.
- For charges incurred for treatment which is given by a person’s spouse or
his or his spouse’s father, mother, son, daughter, brother, or sister.
- For charges incurred for treatment which is given by a person’s employer
or an employee of such employer.
- For charges incurred after a person’s insurance ends; however, dental benefits
may be provided as described in the Benefits After Insurance Ends provision.
- For charges that are not essential for the necessary care or treatment of
the injury or sickness involved.
All person who were previously insured for dental insurance under this plan and later voluntarily end insurance will not be eligible to re–enroll for a period of two years following the date insurance was voluntarily ended.
Effective Date
Your coverage will be effective the first day of the month coinciding with or next following the date your request for insurance is received, provided the required premium is paid. Some services are subject to a 6 or 12–month waiting period; see "Waiting Period" section above.
When Coverage Terminates
Your dental coverage will be terminated only if you fail to pay the appropriate
premium when due; the group policy is discontinued; or insurance ends for
your class. Coverage for dependents will end if your insurance ends, dependents'
insurance ends under the group policy, the person ceases to be a dependent or
premium is not paid for the dependent when due.
Certificate Of Insurance
When you become insured, you will be sent a Certificate of Insurance summarizing the provisions of the Plan under which you are insured.
Payment And Claims
Under the ASME Enhanced Dental Insurance Plan, you can request that the benefits be paid either directly to your dentist, or you can be reimbursed for the benefit. Once you are accepted into the Plan, you will have a 31–day grace period for your payment of renewal premiums.
This plan is underwritten by The United States Life Insurance Company in the City of New York, NAIC No. 70106, domiciled in the state of New York with a principal place of business of 70 Pine Street New York, NY 10270. It is currently authorized to transact business in all states plus DC, except PR. This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. V–610,270, Form No. G–19000. Coverage may vary or may not be available in all states.
The underwriting risks, financial and contractual obligations and support functions associated with products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.
AG–7291T
How to Enroll
Consider Your Eligibility
Before you request coverage, you must be a member in good standing of ASME. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, see the ASME home page.
"30–Day Free Look"
When you become an insured, you will be sent a Certificate of Insurance summarizing
your insurance coverage. If you are not completely satisfied with the terms
of your Certificate of Insurance, you may return it, without claim, within 30
days. Your coverage will be invalidated and you will receive a full refund–
–no questions asked!
To Enroll:
Truthfully complete and sign the enrollment form. Be sure to indicated whether you are requesting coverage for your dependents.
Make your check for the total premium contribution payable to: Administrator, ASME Group Insurance Program.
Mail both your completed enrollment form and your check to:
Administrator,
ASME Group Insurance Program
12421 Meredith Drive
Urbandale, IA 50398
If you have questions about your eligibility or the features of this Plan, including costs, exclusions, limitations and terms of coverage, call a Customer Service Representative toll–free at 1–800–289–ASME (2763).