Download Allstate Benefits Heritage Choice Dental Coverage Frequently

Allstate Benefits
Heritage Choice Dental Coverage
Frequently Asked Questions (FAQs)
Q. How is the plan designed?
A. Benefits are divided into 4 categories. The coverage is designed with a co-pay for basic
wellness procedures (Category 1 Wellness), and a deductible and coinsurance for all other
procedures (Category 1 Other & Categories 2, 3, 4). Category 4 encompasses Orthodontia
services for dependent children under age 19.
Q. How does the coverage work?
A. There is a $15 co-pay for Category 1 Wellness procedures. All other procedures will
require satisfaction of a $50 deductible and be subject to the appropriate coinsurance
amount. The coinsurance benefit amount will increase every year the policy is in force,
with the maximum payout beginning in year 3. Additionally, the Coverage Year Plan
Maximum will increase by $250 for the 2nd and 3rd years as long as the coverage remains in
force. There is also a Coverage Year Plan Maximum of $500 per year for Orthodontia with a
Lifetime Maximum of $1,500.
Q. How is the benefit paid out?
A. Benefit payment is based on a fee schedule (Schedule of Dental Procedures) provided in
the insured’s certificate. The benefit payable is figured by multiplying the covered dental
amount shown for the procedure in the fee schedule by the insured percent. Once the
benefit payable is determined, that amount is remitted to the dentist for services provided
or to the insured if the services were prepaid.
Q. Is there a network associated with this dental plan?
A. No. An insured may use any licensed dental provider.
Q. Will an ID Card be sent to the insured?
A. Yes. An insured will be sent an ID Card to their home address.
Q. Is there a waiting period before using the Dental benefits?
A. There is no waiting period for Category 1 Wellness procedures. However, Category 1
Other and Categories 2, 3 and 4 have a 6-month elimination period that must be satisfied
prior to benefits being paid. This elimination period can be reduced or eliminated with
proof of prior group dental coverage.
Q. Are there medical questions to answer for this coverage?
A. No. This coverage is Guarantee Issue. However, if an employee does not enroll when
initially eligible, they will not be eligible to enroll until the next annual enrollment period
unless they have a Qualifying Life Event (QLE).
Q. Is there domestic partner coverage?
A. This will be contingent upon the situs state of the employer’s policy and the plan
administration.
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Q. To what age can dependent children be covered?
A. Children may be covered until age 26 regardless of financial, marital or student status. He
or she may be covered longer if they continue to meet the definition of a covered
dependent.
Q. Is there an option to continue this coverage after employment terminates?
A. Yes. An insured person may continue their coverage through COBRA. Once COBRA
Continuation has been exhausted, an insured person may continue their coverage through
a Portability Provision. Please call 1-888-580-5140 for additional details.
Q. Who submits claims?
A. Normally the dental provider will submit the claim to Allstate Benefits for reimbursement.
However if a provider requires payment prior to rendering services, then the benefit will be
paid to the insured upon proof of payment.
This material is valid as long as information remains current, but in no event later than August 1, 2014. Coverage is provided by
limited benefit supplemental insurance, policy form GDEN-P or state variation thereof, underwritten by American Heritage Life
Insurance Company. The coverage has exclusions and limitations. Contact your Insurance Agent for costs and complete details.
Allstate Benefits is the marketing name for American Heritage Life Insurance Company (Home Office: Jacksonville, FL), a subsidiary of
The Allstate Corporation. 2011 Allstate Insurance Company.
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