CarePlus GOLD EXCLUSIONS AND LIMITATIONS
Return to CarePlus GOLD Dental Insurance
EXCLUSIONS AND LIMITATIONS
- The Contract does not cover any services performed at offices other than Dental Associates’ in Wisconsin.
- 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:
- individual or family plan health insurance;
- group health insurance;
- medical or hospital service insurance;
- Medicare or Medicaid;
- HMOs, PPOs and other prepaid coverage; and
- union, employer or employee welfare benefit plans.
- The Contract will not reimburse you for missed appointment charges.
- Your spouse will no longer be covered if that person no longer meets the definition of “spouse” under the CarePlus Contract.
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 3333 N Mayfair Road, Wauwatosa, WI 53222. If you do so, the Contract is void and all payments made under it shall be refunded.
If you fail to make any premium payment when due and such failure continues for more than thirty-one (31) days following the Renewal Date, the Contract and all rights you and members of your family have to receive benefits shall terminate.
- The Contract is issued for a term of 12 months. It is renewable at the option of CarePlus.
- 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.
- When the Contract terminates, the right of you and your spouse to benefits shall terminate immediately.
CarePlus may disenroll you, resulting in termination of coverage, for any one of the following reasons:
- You do not pay a required premium within thirty-one (31) days after the Renewal Date.
- You permit someone else to use the enrollment identification or knowingly provide fraudulent information in applying for coverage or receiving services.
- You pose a threat to providers, staff or other policyholders because of physical or verbal abuse.
- 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.