Aug 21, 2019

Preferred Dentist Program Plan Details

How the Plan Works

  • Provides benefits for diagnostic and preventive care as well as most forms of specialty dental treatment. 
  • Allows you to see any dentist you wish.
  • Identify the maximum allowable benefit for each dental procedure on their Schedule of Dental Services. The dollar amount assigned to each procedure is the maximum you receive, not to exceed actual charges.
  • Reimburses you for procedures performed, or you can request that the benefits be paid directly to your dentist.

Freedom to Use Your Own Dentist

With many employer-provided or other types of dental plans, you are required to use a network or participating dentists or seek referrals for specialty treatment. With the AIChE Dental Plan, you are free to choose your own dentist or specialist.

Comprehensive Benefits

The AIChE Dental Plan provides insurance coverage for more than 100 different dental services, including diagnostic, preventive and specialty dental treatments like endodontics, periodontics, oral surgery, prosthetics and orthodontics.

Benefits Paid to You or Your Dentist

Under your dental coverage, you can request the benefits be paid either directly to your dentist, or you can be reimbursed for the benefit.

Effective Date

Your coverage will be effective the first day of the month following receipt of your enrollment form and first premium.

When Coverage Terminates

Your dental coverage will be terminated only if:

  • you cease to be a member of the AIChE;
  • you fail to pay the appropriate premium when due; or
  • the group policy is discontinued.

Coverage for your dependent spouse and children, if enrolling, will be terminated if:

  • your insurance ends,
  • dependents' insurance ends under the group policy, 
  • the person ceases to be a dependent, or 
  • the premium is not paid for the dependent when due.

Certificate of Insurance

When you become insured, you will be sent a Certificate of Insurance detailing the provisions of the plan under which you are insured.

Portable Coverage

Your dental coverage goes with you wherever you go—whether you travel or plan to move—as long as you remain an AIChE member and pay your premiums when due.

Exclusions

This plan does not cover the following services, treatments and supplies:

  • Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature.
  • Services for which a covered person would not be required to pay in the absence of dental insurance.
  • Services or supplies received by a covered person before the insurance starts for that person.
  • Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment.
  • Services which are primarily cosmetic. (For residents of Texas:  Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child).
  • Services or appliances which restore or alter occlusion or vertical dimension.
  • Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease.
  • Restorations or appliances used for the purpose of periodontal splinting.
  • Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
  • Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.
  • Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
  • Decoration or inscription of any tooth, device, appliance, crown or other dental work.
  • Missed appointments.
  • Services covered under any workers’ compensation or occupational disease law.
  • Services covered under any employer liability law.
  • Services for which the employer of the person receiving such services is not required to pay.
  • Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital.
  • Services covered under other coverage provided by the Policyholder.
  • Temporary or provisional restorations.
  • Temporary or provisional appliances.
  • Prescription drugs.
  • Services for which the submitted documentation indicates a poor prognosis.
  • Services, to the extent such services, or benefits for such services, are available under a government plan.  This exclusion will apply whether or not the person receiving the services is enrolled for the government plan.  We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first.
  • The following when charged by the dentist on a separate basis - Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
  • Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food.
  • Caries susceptibility tests.
  • Precision attachments associated with fixed and removable prostheses.
  • Adjustment of a denture made within 6 months after installation by the same dentist who installed it.
  • Duplicate prosthetic devices or appliances.
  • Replacement of a lost or stolen appliance, cast restoration or denture.
  • Intra and extra-oral photographic images.