Dental Associates Preferred

EXCLUSIONS AND LIMITATIONS

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EXCLUSIONS AND LIMITATIONS

1. The Contract does not cover any services performed at offices other than Dental Associates’ in Wisconsin.
   
   
2. The Contract does not cover care if benefits for that care are available to you under other medical or dental expense coverage. Should that occur, CarePlus pays the part of any charge which is more than the other coverage’s benefit, up to the extent of the total benefit listed for that procedure. All other conditions and limitations still apply.
   
   Other medical or dental expense coverage includes:
   
   
   1. individual or family plan health insurance;
   2. group health insurance;
   3. medical or hospital service insurance;
   4. Medicare or Medicaid;
   5. HMOs, PPOs and other prepaid coverage; and
   6. union, employer or employee welfare benefit plans.
      
      
3. The Contract will not reimburse you for missed appointment charges.
   
   
4. A member of your Family will no longer be covered by the Contract if that person no longer meets the definition of Family

NOTICE OF 10-DAY RIGHT TO RETURN CONTRACT

You may return the Contract within ten (10) days after receipt to CarePlus Dental Plans, Inc. at 11711 W Burleigh Street Wauwatosa, WI 53222. If you do so, the Contract is void and all payments made under it shall be refunded.


GRACE PERIOD

If you fail to make any payment when due and such failure continues for more than 31 days following the Renewal Date, this Contract and all rights of you and members of your Family to receive benefits under it shall terminate. If you fail to make any payment when due as a part of a premium installment plan, and such failure continues for more than 31 days following the installment payment date, this Contract and all rights of you and members of your Family to receive benefits under it shall terminate and benefits under the benefit period will be recouped. You will be responsible for charges through Dental Associates as this policy is required to be in force for 1 year.


CONTRACT TERMINATION

1. This Contract is issued for one Benefit Year. It is renewable at the option of Care-Plus.
2. This Contract will terminate if you fail to pay any required premiums owed to Care-Plus by the end of the grace period, as explained below.
3. A person is no longer eligible for this coverage if he or she obtains other dental coverage in addition to this plan. The coverage under this plan for a person with other dental coverage will terminate on the date the person becomes covered under the other plan. No refunds will be provided.
4. The date on which coverage ends is your Termination Date.
5. When this Contract terminates, the right of you and your Family to benefits hereunder shall terminate immediately.
6. In the event that any services are required by you or a member of your Family or are performed after the right to benefits has terminated, expenses incurred for such care shall be the sole responsibility of you and/or the Family member.

DISENROLLMENT

CarePlus may disenroll you, resulting in termination of coverage, for any one of the following reasons:

1. You fail to pay the required premium within 31 days after the Renewal Date.
2. You permit someone else to use the enrollment identification or knowingly provide fraudulent information in applying for coverage or receiving services.
3. You pose a threat to providers, staff, other patients, or other policyholders because of physical or verbal abuse.
4. You are unable to establish or maintain a satisfactory provider-patient relationship with a Dentist. Disenrollment only will occur after we provide you the opportunity to select an alternate provider, have made reasonable efforts to assist you in establishing a satisfactory provider-patient relationship, and have provided you with notice of the right to file a Grievance.
5. If you are dis-enrolled, you may appeal our decision by filing a Grievance.
   
   

Questions about the Dental Associates Preferred dental plan? Call 800-318-7007 to learn how you can save on quality dental care!


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