CarePlus VIP 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 if that person no longer meets the definition of “family” under the CarePlus Contract.

    5. A routine orthodontic case is one in which the alignment of the teeth is accomplished using a single phase of treatment with complete braces and a single set of retainers. Additional costs are incurred when treatment requires appliance therapy, headgear, treatment of impacted tooth/teeth, cleft palate, orthognathic surgical procedures or orthodontic brackets other than stainless steel (i.e. gold, ceramic, invisible, etc.).

     

    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.


    GRACE PERIOD

    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.


    CONTRACT TERMINATION

    1. The Contract is issued for a term of 12 months. It is renewable at the option of CarePlus.

    2. 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.

    3. The Contract will terminate for your children when they reach age 26. Please refer to dental Contract for full description of dependent coverage.

     

    DISENROLLMENT

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

    1. You do not pay a required premium within thirty-one (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 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.

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


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