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CAP Home > Dental insurance details

When it Comes to Dental Health for You and Your Family, Freedom to Choose Is Something to Smile About

Updated July 25, 2005

Questions? Call toll-free: 1-800-509-6023.

While it's an important type of insurance to have, whether you're single, a single parent, or married with a growing family, millions go without dental insurance because the cost to insure as an individual can be too high.

Thanks to your association, you now have an opportunity to enroll for quality dental coverage at affordable group rates. Unlike many so-called "low-cost" plans on the market today, your association-sponsored plan gives you an attractive range of benefits plus freedom to choose your own dentist.

Choose from two affordable plans

While both Plans are truly affordable at our economical group rates, we give you two plans to choose from in order to best suit your needs and budget. But first it is important to note that both plans provide day-one coverage for preventive care with no deductible and no waiting period!

Preventive care is important to long-term dental health. That is why these plans provide first-day coverage for routine exams, cleaning, x-rays, fluoride treatments, and space maintainers.

With that in mind you may choose Plan 1 for a lower deductible, shorter waiting periods, and higher level coinsurance benefits for certain services. While the monthly premiums are a bit more, you may prefer the added security of greater protection against out-of-pocket expenses when the need for services arises.

Or choose Plan 2 if, for a lower monthly premium, you won't mind a higher annual deductible, as well as a longer waiting period and lower coinsurance benefit for certain services if the need arises.

Need help choosing what's best for you?

Call the plan administrator toll-free for assistance: 1-800-509-6023.

Freedom to choose your dentist

Confidence in your dentist is key. That is why these plans allow you to choose any dentist you wish. You can choose from a vast preferred provider network for the optimal benefits of this insurance. And, chances are good that your current dentist is a network member. If not, you are free to keep your own dentist. Benefits will be paid based on the PPO fee schedule agreed to by all network providers.

Annual deductibles

Your deductible is the amount of covered dental charges incurred while you are insured for which no benefits will be paid. But, to help keep your out-of-pocket costs low, the

- Plan 1 deductible is $50 per insured person, maximum of $150 per family per calendar year.

- Plan 2 deductible is $75 per insured person, up to a maximum of $225 per family per calendar year.

Both plans offer a broad range of benefits

Each calendar year, after the cash deductible is satisfied, this plan will pay the specified percentage of the covered charges, up to the fee schedule allowance for such charge.  Please see dental plan options for fee schedules.

Dental Plan Options (PDF, 38.1 K)

Important Coverage Information

Who is eligible

You are eligible to enroll if you are a member and are actively at work for at least 30 hours a week.

You may also enroll your lawful spouse, and/or unmarried children, stepchildren, and adopted children whom you support and who are under age 19 (age 25 if a full-time student).

Calendar year maximum

The maximum amount this insurance will pay for all eligible dental expenses in any calendar year is $1,000 per person for all covered services.

Covered charges

All covered dental services must be provided by or under the direct supervision of a dentist. Charges must be incurred while you are insured under this dental plan in order to be covered. A covered charge is considered incurred on the following dates:

  • Full and partial dentures on the date the master impression is made.
  • Fixed bridges, crowns, cast restorations on the date the teeth are first prepared.
  • Root canals on the date the pulp is opened.
  • All other services on the date the service is performed.

A complete description of covered dental services is provided in the Certificate of Insurance.

Day One Coverage for Accidental Injury

There is no waiting period for expenses due to accidental injury to sound and natural teeth, not including damage to teeth, appliances, or prosthetic devices, that results from chewing or biting food or other substances. Treatment must begin within 90 days of the date of the accident.

Economical group rates

If you have looked for quality individual dental insurance, you know how costly it can be. But because you are eligible for this coverage as part of a group, you will see how strong group purchasing power makes it so much more affordable — in most cases, less than a few dollars a day for full family coverage — regardless of how many dependents you insure.

Download group rates  (PDF, 29.8 K)

Easy to enroll

  1. Select the plan that best suits your needs and budget.
  2. Complete, sign, and mail the enrollment form.  (PDF, 35 K)

Send no money now

If you have any questions, call toll-free for assistance: 1-800-509-6023.

Eligible expenses

Expenses must be incurred while the group policy is in force and the person is covered by the policy. To be an eligible expense, the dental service must be performed by a dentist who is properly licensed or certified under the laws of the state in which he practices to render dental services, perform dental surgery, or administer anesthetics (or fluids and blood incident to anesthesia) for dental surgery.

Such person must act within the scope of his license or certificate.

When coverage begins

Your dental coverage will become effective on the first day of the calendar quarter after your enrollment form has been received (January 1, April 1, July 1, or October 1 only).

When coverage ends

This coverage will end on the earliest of the following:

  • when the premium is not paid when due;
  • when you no longer meet the eligibility requirements;
  • when your spouse is no longer your legal spouse
  • the date your child is no longer your dependent; or
  • when the group policy ends.

Other coverage

The benefits of this plan will be reduced by the benefits payable for the same charge under Medicaid/Medicare or a medical plan issued by United States Life. If a person is insured under any other medical or dental plan, the Coordination of Benefits provision of the group policy may apply.

Exclusions and limitations

No dental care benefits will be paid by the group policy for charges incurred for treatment that:

  1. is given after a person's insurance ends, regardless of when the injury or sickness occurred.

    However, medical care benefits may be provided in the benefits after insurance ends provision of a given benefit section.

  2. is not essential for the necessary care of treatment of the injury or sickness involved.

    "Necessary care or treatment" means care, treatment, services or supplies that are:

    • recommended, approved or certified by a physician as necessary and reasonable, and
    • commonly viewed by the American Dental Association as being proper treatment.
    "Necessary care or treatment" does not mean care, treatment, services, or supplies that are:
    • to train a person for a job or to educate him, or
    • experimental in nature.

  3. would be given free of charge if the person was not insured.

    However, medical care benefits will be paid for covered charges incurred by a state for medical assistance to an insured person under Title XIX of the Social Security Act of 1965.

  4. results from a war or an act of war.

  5. results from intentionally self-inflicted injury.

  6. is given by a person's spouse or the spouse's father, mother, son, daughter, brother, or sister.

  7. is given by a person's employer or an employee of such employer.

  8. a person is entitled to benefits from a workers' compensation or similar law.

  9. is a prosthetic device to replace teeth lost before the person is insured under the group policy.
Charges for the following services or devices will not be covered:
  1. Oral hygiene, unless used in a dentist's office, plaque control, diet instruction
  2. Topical sealants
  3. Precision attachments
  4. Treatment that does not meet accepted standards of dental practice or is experimental in nature.
  5. Orthodontic services.
  6. Appliances or prosthetic devices used to:
    • change vertical dimension;
    • restore or maintain occlusion, except to the extent that this benefit section covers orthodontic benefits;
    • splint or stabilize teeth for periodontic reasons;
    • replace tooth structure lost as a result of abrasion or attrition; or
    • treat disturbances of the temporomandibular joint,
    unless as a result of, and within 24 months of an accident while insured, or for treatment of a congenital defect for a newborn child.
  7. Cosmetic services including, but not limited to:
    • characterizing and personalizing prosthetic devices,
    • making facings on prosthetic devices for any tooth in back of the second bicuspid.
  8. Replacement of an appliance or prosthetic device unless:
    • the appliance or device is at least 10 years old and cannot be made usable, or
    • the appliance or device is damaged, while in the insured person's mouth in an injury which occurs while insured and it cannot be repaired.
  9. Replacement of a lost, stolen, or missing appliance or prosthetic device.
  10. Making a spare appliance or device.
  11. Services or devices for which no charge is made.
The certificate of insurance includes a complete list of limitations and exclusions.

Basic quarterly rates

Download Group Rates (PDF, 29.8 K)

This Economical Group Dental Coverage is underwritten by The United States Life Insurance Company of the City of New York

A+ rating from A.M. Best reflects United States Life's superior overall financial strength and operating performance when compared to A.M. Best's  standards. This is A.M. Best's second highest rating.

The program is administered by:

Affinity Insurance Services, Inc.
159 E. County Line Road
Hatboro, PA 19040-1218

This is a summary of benefits only, and is subject to the terms, conditions and limitations of the Group Policy V-223, 606, form no. G-19000/19001.  Coverage may vary, or may not be available in all states.

 
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