FAQs about American Health Shield dental insurance

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.

Simplify the business of life

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How do you plan to simplify the business of life?

This blog title is a slogan used by the world’s most popular personal and small business software maker. For my purposes as an adviser, I’m using it here to refer to the accounting for essential financial transactions between an employer and employee: payroll, taxes and employee benefits.

Small businesses have wide latitude in some areas of their financial operations (offering employee health insurance, for example) and little margin for variance in others (like employee wage taxes) . Yet the goal is the same for all: accomplish these transactions and reporting requirements timely and accurately at minimal time and expense.

The best practice

Today’s small businesses have enormously powerful tools available at minimal cost. To make the most of these technologies it almost always makes sense to integrate the small business banking, payroll, taxes and employee benefits under one platform with one internal person (often the small business owner) and one outside person (usually the accountant) in charge of these systems. Have a clear written agreement on who is responsible for specific tasks, a timeline and provisions to handle unexpected events. (A copy of my small business engagement agreements are available at tonynovak.com). Integration of services using the latest AI driven technology almost always saves time and money.

What can go wrong?

Of course, very few small business owners deliberately choose to fail on these essential accounting areas. Yet available data indicates that a high percentage have run into trouble in the past. Limited data using newer technology is far more favorable. As an anecdotal observation, the percentage of employers with a wage tax violation is somewhere around 25%. The percentage of clients with a violation using current wage tax platform is 0%. The technology works! The most common problem issue is lack of appropriate budget to accounting functions. A typical small business devotes 2% to 4% of its gross revenues on these requirements. These are benchmarks and certainly some fall outside that range. But businesses that go much below are typically the ones that run into tax, accounting or financial management trouble.

How to look for savings

The easiest way to is to request an initial analysis of your current financial accounting operations. An experienced adviser can compare this to the norms among similar small businesses and recommend approaches that are working better lately. This service is available for a small fee that is likely only pennies on the dollar of savings available. The analysis process from beginning to end likely takes a few discussions totaling an hour or two. When I handle these engagements I prepare a one page report for the business owner in checklist format so that we can discuss and easily prioritize the areas of potential gains. In today’s rapidly evolving technology environment, it makes sense to re-evaluate every two years or so. In most cases, business owners tell me they were not even aware of the existence of the most common cost-saving and time-saving tools.


My question to other small business owners: How do you plan to simplify the business of life? I would be pleased to hear your thoughts. Reach me online or call/text 302-404-3263.

Does a waiting period apply to coverage for accidents and injuries?

Health insurance coverage is complex so clarification is often requested on specific issues. We are pleased to provide that personal assistance as requested.

The most popular supplemental insurance plans include some type of exclusion of coverage for claims that exist prior to the policy. This helps keep premium rates affordable and, of course, discourages members from enrolling immediately prior to receiving planned medical treatment. For Core Health Insurance, that exclusion applies during the first 30 days of a newly issued policy. Other policies will have their own waiting period details.

That exclusion does not apply to claims for accidents or injuries, the types of claims that may require medical treatment.

For a more complete explanation see the coverage details from the online quote page and contact us for clarification on any details.

 

The most profitable New Year’s resolution: one that you can knock off in an hour

At this time of year we can read plenty of articles giving advice for the next year. The most popular articles seem to focus on how to do more, be better, and rise to new heights. Few of these articles focus on more mundane issues like saving a few minutes on daily work flow, saving taxes, or cutting business overhead expense. Yet these contribute to profitability in the same dollar-for-dollar way as other financial plans. In reality, the later type of focus on financial efficiency is more likely to to be immediately profitable to a larger number of people.

Think of your accountant as an efficiency expert. We know how to save time and money. We know what has worked best for other people like you. We start by listening to your story and challenges and then developing a checklist of possibilities for improvement. The good news is that this important first step can usually be done in an hour. Your small investment in just listing those possibilities will undoubtedly be the most profitable thing you can do to prepare for the year ahead.

Of course, everyone’s situation is unique. It is not possible to simply copy a generic ax and financial savings checklist as a formula for yourself. But you can get a jump start on saving time and money for the new year by scheduling a call or meeting to review your current situations and developing an action plan to make this the most profitable year yet.

Happy New Year!

Change of tune: Trump administration seeks to reaffirm Obamacare

In a surprise move Friday, December 21, lawyers for the Trump administration filed a brief asking U.S. District Judge Reed O’Connor, federal judge in Texas who declared Obamacare unconstitutional, to downplay the impact of the case. The Trump administration wants to reassure the public his decision was not effective immediately and he did not intend “substantial disruption to the healthcare markets” after the presidents’s misleading public comment made about the December 14 court ruling. The president wrote “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster!”. Late the White House Communications Office issued a corrective statement “the law remains in place” and was not, in reality, “struck down”.

U.S. Justice Department originally backed the court case to declare Obamacare unconstitutional but now realizes that they have no other plan to fund healthcare. The Trump officials want to assure the public that Obamacare is still the ‘law of the land’ despite the president’s statements that “Obamacare Is dead” that are meant for political purposes and are not meant to confuse people or to lie to the public about the availability of legally available health coverage under Obamacare. At least one public official believes that Trump can be held legally liable for his lies that could cost people to forfeit government-provided health insurance.

The issue is expected to be resolved in the when the Democrat-led Congress regains power and resumes a “healthcare for all” agenda. Neither the Judge’s ruling nor the U.S. Justice Department have any effect on the private commercial health plans listed at Freedom Benefits that are exempt from most Obamacare laws.

Health insurance enrollment after the 12/15 seasonal deadline

2019 health insurance enrollment season ended 12/15/2018. That doesn’t mean that there are no coverage options.

For those who lose coverage for reasons outside their control, extended open enrollment For plans that offer full takeover of pre-existing condition coverage may be available.

Those who spend down their assets on heath care and still have insufficient income to pay for ongoing care are often eligible for Medicaid plans.

A number of limited benefit plans are available any time of year. These limit or exclude coverage for pre-existing conditions. The trade-off is that these plans are more affordable.

If you find a need for coverage outside of enrollment season, a chat with a health insurance specialist is smart place to start. OnlineNavigator offers this off-season support on request.

Freedom from Obamacare! “Great news for America!”

“ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas. Great news for America!” – President Donald Trump, Friday December 14, 2018, commenting on his most recent court victory.

Freedom Benefits is proud to design individual and small business health benefit plans for 2019 free from the unconstitutional constraints of the Affordable Care Act in all states that do not have laws that directly compete with this new legal ruling. After Congress tried and failed to destroy the Affordable Care Act and protections for pre-existing conditions, a Texas court was successful in overturning the law in a case brought by 20 states.

If you want to implement a health plan free from Obamacare, it is important to act quickly . The IRS and insurance companies consider health plans to operate on a calendar year basis so the sooner you get started at the beginning of the year, the greater the benefit.

To get started with a no-obligation planning discussion, call or text OnlineNavigator service at (302) 404-3263 to schedule an introductory phone call.

Early 2019 health insurance enrollments are down

As of December 1, a combined total of 32 million people had enrolled for 2019 health insurance from the 39 states participating in the healthcare.gov platform. This total is down by 11 percent when compared to the same time in 2017. 

Last year over two thirds of Americans who enrolled in Obamacare plans purchased from the marketplace signed up in the last two weeks of the enrollment season. It appears to be a growing tradition for the vast majority of the sign-ups to occur close to the end of the open enrollment period.

The Kaiser Family Foundation conducted a poll from which the results showed that about 70 percent of Americans don’t know that the enrollment deadline this year is December 15. 

In general, most health insurance exchanges report that enrollments this year are lower than last year. Yet at least one enrollment firm reports that enrollments have increased this season. It appears that firms with more technologically advanced platforms hold an advantage in recruiting new health plan members. Freedom Benefits notices that access to live enrollment support at the point of enrollment, either by telephone or online, also has a positive impact on enrollments.

Enrollment for the supplemental and alternate plans listed on FreedomBenefits.net remains open year-round. Some but not all of thee plans  are available ithout regard to serious medical history. None of these plans provides the same level of coverage for pre-existing medical conditions as the plans from the government’s Health Insurance Marketplace.

The real small business health benefit

Your employees already have health insurance. Chances are they found coverage though the Health Insurance Marketplace with a premium subsidy that gives then a lower net cost than anything your business could provide.

But the benefits are lacking. The large deductible leaves them scared. Nobody has an extra $5,000 or more just sitting around in case of an accident or illness! And what about lost wages during time off from work? What can you do to help?

The employer can offer inexpensive supplemental gap insurance that pays cash benefits in addition to the primary insurance. The cost can be as little as $20 per month. And because it is provided through an insurance plan, your employee does not risk losing their premium subsidy.

Check out Smart Insurance Marketplace to learn more. Live help is available by phone and email.

health benefits

Low cost health insurance expands

President Trump signing
President Trump authorized new health plan options

The market for lower cost affordable health insurance is expected to grow with at least to more companies making public securities market offerings for expansion. Bright Health and Oscar Health both completed successful public offerings this year.  These health plans offer lower beenfits at a lower cost in states that allow these alternatives. President Trump pushed for approval of these plans that were previously prohibited by Obamacare. Not all plans are available in all states.

Freedom Benefits has served as a leading adviser in this field since 1995. We support freedom of choice for well-informed consumers and we will continue to monitor, review and recommend these alternative health plans as they develop. Personal support is available online or by telephone.