American Health Shield Dental Insurance is no longer available but some carriers may wish to refer to the design elements.
Reproduced from the American Health Shield online quoting and enrollment Web site. Other pages about the former product were removed to prevent confusion.
What is the difference between Plan A, Plan B and the PPO Plan?
Plans A and B are traditional indemnity options which give you freedom of choice in providers and reimbursement is based upon usual and customary charges. Maximum yearly benefit is $1,250. The PPO Plan is a Preferred Provider Organization, which provides richer benefits for “in-network” based upon contracted, negotiated fees. Should you choose to go “out-of-network”, the benefits are reduced and reimbursement is based upon usual and customary charges. Maximum yearly benefit is $2,000.
How do I look up a preferred dental provider in my area?
Preferred dental providers can be found by searching here:
Who is eligible for this coverage?
This plan is offered to individuals and their spouse age 18 or older
, and their unmarried dependent children (from birth to age 19 or 25 if a full-time student -subject to state requirements). All persons listed on the Application for Coverage must reside at the same home address.
When does my coverage start?
Your insurance coverage will begin on the 1st of the month (at 12:00 am), following receipt of the completed Application for Coverage form and payment of the first month plan cost.
What are my payment options?
You can pay in monthly installments by credit card (MasterCard or VISA) or Electronic Funds Transfer (EFT) from your bank.
Can I enroll my dependents?
Yes, your legal spouse, your dependent unmarried children to the end of the calendar year in which they turn 19, or your unmarried children who have not reached their 25th birthday, are allowed to enroll if the child is (1) dependent upon you for support and (2) living in your household.
How do I file a claim?
Download a Claim Form, complete it and mail to:Renaissance Dental = Payor RLHA1 P. O. Box 17250 Indianapolis, IN 46217Or, you may call our Customer Service department at Co-ordinated Benefit Plans at 866-753-1002 to request a claim form during daily business hours, 8:30 am – 5:00 pm EST Monday-Friday.
How can I check the status of my claim?
You may call Renaissance Dental Customer Service at 888-358-9484. (Please be sure to have your membership ID# available at the time of the call.)
Am I covered for all dental services?
You are covered only for the services provided under the Plan option you selected. Please refer to your Summary of Dental Plan Benefits for a complete description of the dental services provided by this Plan. Please read them carefully. For a complete listing of Exclusions and Limitations, refer to your Certificate of Coverage or master Policy.
Are these dental plans available in every state?
No
, these plans of dental insurance are NOT currently available to residents of the following states:
PLAN A: AK, CO, HI, MT, NE, NV, NY, ND, VT, WA
PLAN B: AK, CO, HI, MT, NE, NV, NY, ND, VT, WA
PLAN PPO: AK, CO, CT, DE, DC, GA, HI, KY, ME, MD, MN, MT, NE, NV, NH, NJ, NY, NC, ND, OK, SD, TN, TX, UT, VT, VA, WA, WY
The PPO Plan is not available in the following counties:
Massachusetts – Dukes County, Nantucket County
Pennsylvania – Adams County, Bradford County, Cameron County, Forest County, Fulton County, Montour County, Potter County, Sullivan County, Warren County, and Wyoming County.
What is the benefit year maximum?
The benefit year maximum is the maximum amount payable for all Covered Dental Charges in any benefit year as shown in the Coverage Schedule. The Benefit Year Maximum will apply to each insured person.
Is there any kind of waiting period?
Yes, 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.
Is a benefit year based on a calendar year?
No, the benefit Year is based on a 12-month period beginning with the covered person’s effective date.Do these plans cover orthodontic services?Yes, the plans cover orthodontic services for dependent children to the age of 19. The 24-month waiting period applies.May I choose any dentist?Yes, you are free to choose any Dentist, as long as the Dentist is licensed to practice dentistry in the state or country in which you receive care.
Will RLHICA send payment to the Dentist, or will I receive payment?
RLHICA will either send payment to you or directly to the dentist if you have assigned benefit payments to the dentist who rendered the covered services.
What if I decide to cancel my policy?
The primary insured may cancel his or her coverage with written notice received 31 days prior to the next billing cycle. Any and all future payments will be discontinued. We will not refund any portion of payments collected before receipt of cancellation.
What are the plan’s benefits, exclusions and limitations?
The following forms are available in PDF format:
Benefits, Exclusions and Limitations for Plan A and Plan B
Benefits, Exclusions and Limitations for PPO Plan
Where can I find more information?
More information is available on the American Health Shield product page and the online quoting page. A brief profile of the Renaissance Life and Health Insurance Company of America is also available.