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Review of American Health Shield Dental Insurance

TA | January 1, 2010

Contents:
Summary
Intended Use
General Eligibility
Medical Eligibility
Approved States
Covered Charges
Maximum Benefit
Waiting Period
Exclusions
Pre-existing Conditions
PPO Network Providers
Referrals
Pre-certification
Deductibles
Co-payment
Co-insurance
Length of Coverage
Insurance Company
Plan Administrator
Financial Strength and Ratings
Consumer Complaints
Consumer Reviews
Price
Billing Method
Payment Method
To Cancel Coverage
Online Quote and Application
Brochure
Paper Application
Fax Application
Policy Issue Time
Child Only Applications
ID Cards
Enrollment Support
Billing Support
Claims
Pre-certification
Advantages
Disadvantages
Comments

Summary
This high benefit level traditional indemnity type of dental insurance is available throughout most of the U.S. and can be used to cover 50% to 75% of the cost of services up to $1,250 per year with any dentist of your choice. Claims may be submitted by the dentist or the patient. Up to $1,000 is available for orthodontic treatment. Benefits increase the longer the policy is in force. Maximum benefits for major services become effective after the policy has been in force for two years. The premium ranges from about $25 per month for the least expensive single coverage to $125 per month for the best family coverage.

Intended Use
This insurance is intended for individuals and families without employer-provided dental coverage who anticipate significant dental charges in excess of $1000 per year over the next several years. This insurance pays part of the covered dental charges with any dentist of your choice. Since benefits increase over time as the policy is in force for the first two years, this plan is not suitable for short term insurance coverage. American Health Shield Dental Insurance is an affordable plan of comprehensive dental benefits for individuals and their family members. AHS is underwritten by Renaissance Life and Health Insurance Company of America (RLHICA), bringing over 50 years of knowledge and experience to our customers.

General Eligibility
This plan is offered to individuals and their spouse ages 18 through 64 and their unmarried dependent children (from birth to age 19 or 23 if a full-time student - subject to state requirements).  All persons listed on the Application for Coverage must reside at the same home address. All applicants must be become members of the American Travel Services Trust at the time of application.

This insurance is also available to employees through an employer-sponsored voluntary benefit plan. Where two certificate holders are eligible under the same group and are legally married to each other, they will be enrolled under one application card and will receive benefits under a single policy without coordination of benefits under the RLHICA Dental policy.

Medical Eligibility
Applicants are eligible for coverage without regard to their medical or dental history.

Approved States The following states have approved this coverage as of the date of this article:
Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), California (CA), Delaware (DE), District of Columbia )DC), Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas (KS), Kentucky (KY), Louisiana (LA), Maine (ME), Massachusetts (MA), Michigan(MI), Minnesota (MN), Mississippi (MS), Missouri (MO), New Jersey (NJ), New Mexico (NM), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR), Pennsylvania (PA), Rhode Island (RI), South Carolina (SC), South Dakota (SD), Tennessee (TN), Texas (TX), Utah (UT), Virginia (VA), West Virginia (WV), Wisconsin (WI), and Wyoming (WY).

This product is not available in Colorado (CO), Connecticut (CT), Maryland (MD), Montana (MT), North Dakota (ND), Nebraska (NE), New Hampshire (NH), Nevada (NV),  New York (NY), Vermont (VT) and Washington (WA). See the Listing of State Availability for other options in these states.

Covered Charges
American Health Shield Dental Insurance is available at two different levels of benefits: "Plan A" and "Plan B" that can be selected from the online quote page.

 

This is a summary of benefits for "Plan A"

A "Benefit Year" is the 12 month period beginning with covered person's effective date.

Covered Services - RLHICA Pays You Pay
Class I Benefits
Diagnostic and Preventive Services - Used to evaluate existing conditions and/or to prevent dental abnormalities or disease (includes exams, cleanings, bitewing x-rays and fluoride treatments) 100% 0%
Class II Benefits
Emergency Palliative Treatment - Used to temporarily relieve pain 75% 25%
Radiographs/Diagnostic Imaging - X-rays as required for routine care or as necessary for the diagnosis of a specific condition 75% 25%
Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, silver fillings and white fillings) 75% 25%
Simple Extractions - Simple extractions including local anesthesia, suturing, if needed and routine post-operative care 75% 25%
Sealants - Sealants for the occlusal surface of first and second permanent molars not covered not covered
Periodontal Maintenance - Periodontal maintenance following active periodontal therapy 75% 25%
After Hour Visits - Services performed during after hours visits by a dentist 75% 25%
Consultations - Benefits for consultations by a dentist other than the practitioner providing treatment 75% 25%
Class III Benefits
Oral Surgery Services - Extractions and dental surgery, including local anesthesia, suturing, if needed, and routine post-operative care 50% 50%
Endodontic Services - Used to treat teeth with diseased or damaged nerves (for example, root canals) 50% 50%
Periodontic Services - Used to treat diseases of the gums and supporting structures of the teeth 50% 50%
Major Restorative Services - Used when teeth can't be restored with another filling material (for example, crowns) 50% 50%
Prosthodontic Services - Used to replace missing natural teeth (for example, bridges, dentures, and implant services) 50% 50%
Relines and Repairs - Relines and repairs to bridges, removable bridges, partial dentures, and complete dentures 50% 50%
Occlusal Guards - Benefits for occlusal guards, and limited occlusal adjustments 50% 50%
Office Visits - Office visits during regularly scheduled hours 50% 50%
Class IV Benefits
Orthodontic Services - Services, treatment, and procedures to correct malposed teeth including Orthodontic Services for Children to the age of 19 50% 50%

 

These are the benefits for "Plan B":

Benefit Year -   12 month period beginning with covered person's  effective date.

Covered Services - RLHICA Pays You Pay
Per Visit Deductible
Office Visit
  $20
Class I Benefits
Diagnostic and Preventive Services - Used to evaluate existing conditions and/or to prevent dental abnormalities or disease (includes exams, cleanings, bitewing x-rays and fluoride treatments) 50% 50%
Class II Benefits
Emergency Palliative Treatment - Used to temporarily relieve pain 50% 50%
Radiographs/Diagnostic Imaging - X-rays as required for routine care or as necessary for the diagnosis of a specific condition 50% 50%
Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, silver fillings and white fillings) 50% 50%
Simple Extractions - Simple extractions including local anesthesia, suturing, if needed and routine post-operative care 50% 50%
Sealants - Sealants for the occlusal surface of first and second permanent molars not covered not covered
Periodontal Maintenance - Periodontal maintenance following active periodontal therapy 50% 50%
After Hour Visits - Services performed during after hours visits by a dentist 50% 50%
Consultations - Benefits for consultations by a dentist other than the practitioner providing treatment 50% 50%
Class III Benefits
Oral Surgery Services - Extractions and dental surgery, including local anesthesia, suturing, if needed, and routine post-operative care 50% 50%
Endodontic Services - Used to treat teeth with diseased or damaged nerves (for example, root canals) 50% 50%
Periodontic Services - Used to treat diseases of the gums and supporting structures of the teeth 50% 50%
Major Restorative Services - Used when teeth can't be restored with another filling material (for example, crowns) 50% 50%
Prosthodontic Services - Used to replace missing natural teeth (for example, bridges, dentures, and implant services) 50% 50%
Relines and Repairs - Relines and repairs to bridges, removable bridges, partial dentures, and complete dentures 50% 50%
Occlusal Guards - Benefits for occlusal guards, and limited occlusal adjustments 50% 50%
Office Visits - Office visits during regularly scheduled hours 50% 50%
Class IV Benefits
Orthodontic Services - Services, treatment, and procedures to correct malposed teeth including Orthodontic Services for Children to the age of 19 50% 50%

 

Maximum Benefit
The maximum benefit for either Plan A or Plan B is $1250 per person total per Benefit Year on Class I, Class II and Class III Benefits collectively and $1000  per person total per Lifetime on Class IV (Orthodontic) Benefits. Benefit payment will be based on the Allowed Amount method of payment.  If the Submitted Amount is more than the Allowed Amount, the Certificate Holder is not only responsible for paying the Dentist that percentage of the Allowed Amount listed in the - You Pay - column, but is also responsible for paying the Dentist the difference between the Submitted Amount and the Allowed Amount.  RLHICA determines Allowed Amount based upon treatment rendered and the periodically determined 80th percentile of fees charged by a sample of Dentists of similar training within your geographic area.

Waiting Period
All Certificate Holders (and their Dependents, if covered above) will be eligible for coverage for Class II Benefits 6 months following the effective date of the Certificate Holder or Dependent.

All Certificate Holders (and their dependents, if covered above) will be eligible for coverage for Class III Benefits 12 months following the effective date of the Certificate Holder or Dependent.

All Dependents under age 19, (if covered above) will be eligible for coverage for Class IV Benefits 24 months following the date the dependent enrolled.

Exclusions
The following Services are not covered by the American Health Shield - Voluntary Dental Insurance plan:  

- Services for injuries or conditions paid pursuant to Workers Compensation or Employer's Liability laws;

- Services or appliances started prior to the covered person's effective date;

- Treatment by other than a Dentist or licensed dental hygienist;

- Correction of congenital or developmental malformations, cosmetic surgery or dentistry for aesthetic reasons;

- Medications and prescription drugs;

- Services for the diagnosis or treatment of temporomandibular (TMJ/TMD) disorders;

- Inlays;

- Lost, missing or stolen appliances of any type;

- Pulp caps, maxillofacial prosthetics or myofunctional therapy;

- Services or supplies received as a result of dental disease, defect or injury due to an act of war, declared or undeclared; and

- Charges related to hospitalization or general anesthesia and/or intravenous sedation for restorative dentistry.

 

This is not a complete listing of plan Exclusions. For a complete listing, refer to the Policy or Certificate

Pre-existing Conditions
Pre-existing conditions are covered the same as other covered charges. There are no additional exclusions for pre-existing conditions.

PPO Network Providers
This insurance plan does not use network providers. You may use any dentist or provider of your choice anywhere in the United States. The same level of benefits is paid to all providers regardless of their PPO network affiliations. There is no "out-of-network" reduction in benefits.

Referrals
This plan does not require referrals for treatment. Treatment provided by any doctor or hospital in the United States may be covered without a referral.

Pre-certification
This insurance does not require pre-certification.

Deductibles
Plan A uses a $50 deductible per person total per Benefit Year. The Benefit Year starts on the month the policy started and may different from a calendar year. Plan B does not use an annual deductible.

Co-payments
Plan B uses a $20 per office visit co-payment. Plan A does not use co-payments for each visit.

Co-insurance
This policy uses a 25% or 50% co-insurance. See the columns that says "You Pay" in the coverage summary above for details.

Length of Coverage
The Policy is renewable month to month at the option of the Master Policyholder or the Insurer. Upon 31 days prior written notice, the Insurer reserves the right to change the premiums, subject to state specific requirements. Coverage may be terminated by the primary insured or the Insurance Company upon 31 days prior written notice to the other party, or for other reasons stated in the Policy or Certificate

Insurance Company
Renaissance Life and Health Insurance Company of America (RLHICA). The Renaissance Dental team is knowledgeable in all aspects of dental coverage and care. RLHICA is a member of the Renaissance family of companies, the first of which opened its doors in 1957. Collectively, the Renaissance companies are an industry leader-one of the nation's largest dental plan administrators providing coverage for more than six million people with annual revenues of nearly $2 billion.

Plan Administrator
American Health Shield Dental Insurance is administered by Co-ordinated Benefit Plans, Inc. (CBPI), P.O Box 20594, Tampa, FL 33622-0594.  1-727-799-9188 Local, 1-800-753-1000 National, 1-727-799-9093 Facsimile.  CBPI is a nationally licensed, full service Third Party Administrator located in Clearwater, Florida.  Founded in 1980, the Company maintains a long and distinguished history of competence and professionalism in servicing agents, policyholders and their insurers. CBPI distributes and services a wide variety of accident, health, and specialty programs including (but not limited to) Short Term Medical, International Medical, Limited Benefit Medical and Hospital Indemnity Expense, Life, Dental, Travel Insurance and related services, and Employer Stop-Loss. The company's slogan is "We are service...". This is the same company that administers the popular American Health Shield short term medical insurancenationwide.

Financial Strength and Ratings
Renaissance Life and Health Insurance Company of America is rated "B++" (Secure) by AM Best. Summary Company Financial Information:
Gross Written Premium for 2006 - $742,979
Assets as of 12/31/2006 - $14,042,803
Liabilities as of 12/31/2006 - $3,803,769

Consumer Complaints
The National Association of Insurance Commissioners (NAIC) collects data on consumer complaints against insurance companies and publishes compiled information on its Web site at www.NAIC.org. The NAIC assigns an "average complaint ratio" as 1.0 measurement. Fairmont Insurance received a 0.00 complaint ratio for 2006 which means that the overall number of customer complaints was very low compared to an average insurance company.

Consumer Reviews
Since this is a relatively new insurance product, consumer reviews are not yet available. Reviews will be posted at www.MedSave.com in the near future. We welcome consumer comments for inclusion in future revisions of the product review. If you have a comment or product review, send an e-mail to OnlineAdviser@medsave.com.

Price
Price is based on the plan type (Plan A or Plan B), location (zip code) and coverage status of each applicant (single, applicant and spouse, applicant and children and family). Premium rates are available online. Monthly premium rates average about $25 to $35 for single coverage, and $75 to $125 for family coverage.

Billing Method
The policy is billed on a month-to-month basis.

Payment Method
Payment is accepted by credit card (MasterCard or VISA) or auto bank withdrawal.

Cancel Coverage
If you wish to discontinue coverage, simply mail or fax your written request for termination to the Plan Administratorand they will discontinue future automated electronic debits.  Five days advance written and signed notice from the Primary Insured is required to ensure future credit card debits are discontinued.

Online Quote and Application
Most short term medical insurance policies are priced and issued directly online. This policy is available through MedSave.com. The direct enrollment link is http://dntl1.cbpinsure.com/process.cfm?pageid=1&a=480783198.

Brochure
A product brochure in PDF format is available for download from MedSave.com. The direct link is http://www.medsave.com /images/American-Health-Shield-Dental.pdf

Paper Applications
Paper applications are not available as of March 1, 2009. Please use the secure online enrollment service.

Fax Application
Faxed applications will not accepted as of March 1, 2009. Please use the secure online enrollment service.

Policy Issue Time
The effective date issued will begin on the 1st of the month (at 12:00am), following the Plan Administrator's receipt of the completed Application for Coverage form and payment of the first month plan cost.

Child-Only Applications
Children can apply only with a covered adult. Child-only applications are not accepted.

ID Cards
This policy uses plastic ID cards that are sent by mail when the policy is issued, usually within one business day after online application.  Temporary paper ID cards are available at the time of application by following the link on the confirmation e-mail.

Enrollment Support
Professional enrollment support is provided by OnlineAdviser under the terms of service posted at MedSave.com.

Billing Support
Billing support for issued policies is provided by the Plan Administrator.

Claims
Claims may be submitted by either the policyholder or a medical service provider. Send claims to the Plan Administrator.
 
Pre-Certification

Pre-certification is not required for covered procedures.

Advantages
Any dentist may be used and the claim may be paid directly to the dentist or the patient. This is one of the few plans that provide such liberal benefits for orthodontic treatment. The Plan Administrator is among the most reliable in the employee benefits industry. "American Health Shield" is a well-recognized brand name in individual insurance. This plan pays a relatively high level of benefits compared to most individual dental insurance plans available in the past.

Disadvantages
Maximum benefits for major dental services to not accrue until the policy has been in force for two years. The premiums are higher than most other individual dental insurance plans.

Comments
This insurance product was introduced at MedSave.com in January 2008.

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