Discount Dental Plan Terms and Conditions

Colorado Alpha Discount Dental Plan Terms, Conditions, and Membership Agreement

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By submitting the online membership application I signify, understand and agree:

1. A monthly administrative fee, $1.50, is included in the draft amount.
2. I hereby agree to remain in the Dental Plan a minimum of one year. Less than one year membership may result in my being billed from the Alpha Dental Plan provider the normal rates for dental services provided, minus payments for services rendered during the year.
3. That fee schedule rates from Alpha Dental Plan are available through the offices of participating general dentists only. I am aware that Dental Specialists are not available in all areas, and they apply a flat Discount for services. 
4. I will make all scheduled payments to the Alpha Dental Plan provider at the time services are rendered.
5. I know this is NOT insurance.
6. I have read all covered services, payment schedules, and exclusions offered by the Alpha Dental Plan.
7. I hold Beta Health Association, Inc. blameless for any harm or loss arising from services or omission of services by the providing dentist and his staff.
8. Beta Health Association, Inc. is the Administrator for the Alpha Dental Plan.
9. I understand that I am continuously signed up for this plan until I cancel my plan. To cancel I must notify Beta Health Association, Inc. in writing 30 days in advance and will be responsible for any insufficient charges.
10. Auto renewal/recurring payments will be setup on either your credit card or as an eCheck based on the rate, number of members, and payment frequency option you select, occurring on the 17th of the month prior to your renewal date.

Payment Periods and Billing

By submitting the online membership application, I authorize Beta Health Association, Inc. to charge my Credit Card or Checking account on 4/2/2020 for membership in the Alpha Dental Plan. I further authorize Beta Health Association, Inc. to charge my Credit Card or Checking account on the 17th of the month, monthly, quarterly, or annually based on my selections, for the amount of the membership fees until I cancel or change my membership. The company name shown on your account will be Dental Plan Membership or 800-807-0706.

Choice+ and Care Choice Discount Dental Plan Terms and Conditions

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Renewal Conditions:

By joining a plan, you are authorizing Beta Health Association, Inc. to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Beta Health Association, Inc. in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.

Termination Conditions:

Beta Health Association, Inc. and Careington International Corporation (Careington) reserve the right to terminate plan members from its plan for any reason, including non-payment. If Beta Health Association, Inc. terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.

Cancellation Conditions:

You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Beta Health Association, Inc. will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Beta Health Association, Inc., 6200 South Syracuse Way, Suite #460, Greenwood Village, CO 80111 or fax to (303) 369-1051. You may also submit cancellation requests by email: cancel@betaplans.com. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in FL, ND and OK, where you will receive a pro-rata refund whenever you cancel.

Description of Services:

Please see our dental plan web site for a specific description of the programs included in your plan.

Limitations, Exclusions & Exceptions:

This plan is a discount membership program offered by Careington. Careington is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by Careington. Careington is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased.

Complaint Procedure:

If you would like to file a complaint or grievance regarding your plan membership, you must submit your grievance in writing to: Careington International Corporation, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process and you remain dissatisfied, you may contact your state insurance department.

Disclosures:

THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at Dental plan web site. A written list of participating providers is available upon request. You may cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN residents will be refunded processing fee). Discount Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.

This plan is not available in Vermont or Washington.

Dental And Vision Insurance Terms and Conditions

Authorization Agreement

Payment Options

I authorize Ameritas Life Insurance Corp. to initiate electronic debit entries to my account chosen above for payment of my insurance premium. I certify that I am an authorized user on the above listed account. I acknowledge that debits to my account for premium due will occur on a regular recurring basis based on the payment frequency indicated above until such time as coverage terminates or until I notify Ameritas to terminate these transactions. I understand that it may take up to two weeks to process a request to discontinue recurring payments. In order to make changes to this authorization (such as change in bank account, method of payment, or termination of payment) I must provide Ameritas at least two weeks notice in advance of the next scheduled payment date.

Payment Information:

Initial premium will be withdrawn within 3 days of your policies effective date, subsequent premiums are due on the day of the month in which the policy was effective.

For initial payments I acknowledge that Ameritas may debit my account upon acceptance and approval of my application. Based upon my authorization, Ameritas will process reoccurring payments on or within three business days of the date of the month in which my policy was first effective.

If any authorized payment is returned or dishonored by my bank, I acknowledge that I am responsible for any fees my bank may charge. I understand also that I may incur a return payment fee of $25 charged by Ameritas if the return is due to insufficient funds. I acknowledge that such a fee, if charged, may be automatically debited from my authorized account on the next payment date. I am responsible for remitting payment within the policy grace period. If payment is not received by Ameritas within the defined grace period I acknowledge that my coverage may be canceled in accordance with the terms of the insurance contract.

I also acknowledge that I have read the following information from Ameritas regarding this electronic signature.

• I may return my policy within the right-to-cancel period as described in my policy;
• I acknowledge receipt of the Outline of Coverage (in states where required by law);
• I understand the policy I am applying for provides dental and (if chosen) vision benefits only and is not a Medicare supplement;
• I acknowledge that the agent of record, if applicable, is my insurance agent for purposes of the Ameritas Privacy Policy; and
• I understand that it is my responsibility to give notice to Ameritas of changes in my email address or any information above, as well as my status and my family's status that effect coverage, such as marriage, births, or death of someone covered under the policy. I will provide notice via email at cs@ameritas.com, fax at 402-309-2598 or in writing to Ameritas or its designee: PO Box 82607, Lincoln, NE 68501-2607.

You are encouraged to print a copy of your electronic forms to retain for your own records.

Dental Limitations and Exclusions

Dental Limitations and Exclusions

Covered expenses will not include and benefits will not be payable for expenses incurred:

• for any treatment which is for cosmetic purposes.
• to replace any crowns, inlays, onlays, veneers, complete or partial dentures within five years of the date of the last placement of these items. But if a replacement is required because of an accidental bodily injury sustained while the Insured person is covered under this contract, it will be a covered expense.
• for initial placement of any dental prosthesis or prosthetic crown unless such placement is needed because of the extraction of one or more teeth while the insured person is covered under this contract. But the extraction of a third molar (wisdom tooth) will not qualify under the above. Any such appliance or fixed partial denture must include the replacement of the extracted tooth or teeth.
• for any procedure begun before the insured person was covered under the policy.
• for any procedure begun after the insured person's insurance under the policy terminates; or for any prosthetic dental appliances installed or delivered more than 90 days after the insured's insurance under the policy terminates.
• to replace lost or stolen appliances.
• for appliances, restorations, or procedures to:
• alter vertical dimension;
• restore or maintain occlusion; or
• splint or replace tooth structure lost as a result of abrasion or attrition.
• for any procedure which is not shown on the Table of Dental Procedures. (There may be additional frequencies and limitations that apply, please see the Table of Dental Procedures in the policy.)
• for orthodontic treatment under the following provisions:
• for treatment begun on or after the insured's 19th birthday;
• for treatment begun before the insured became covered under this section;
• for which the insured person is entitled to benefits under any workmen's compensation or similar law, or charges for services or supplies received as a result of any dental condition caused or contributed to by an injury or sickness arising out of or in the course of any employment for wage or profit (except in CA & KY).
• for charges for which the insured person is not liable or which would not have been made had no insurance been in force.
• for services which are not required for necessary care and treatment or are not within the generally accepted parameters of care.
• because of war or any act of war, declared or not.
• if two or more procedures are considered adequate and appropriate treatment to correct a certain condition under generally accepted standards of dental care, the amount of the covered expense will be equal to the charge for the least expensive procedure.

Vision Limitations and Exclusions

VSP Vision Limitations and Exclusions

What is not covered?

Covered expenses will not include and no benefits will be payable for:

• Vision examinations, lenses and frames more than the frequency as indicated on the plan summary page.
• Orthoptics or vision training and any associated supplemental testing.
• Plano lenses (lenses with refractive correction of less than plus or minus .50 diopter) except as specifically allowed in the frames benefit section of the Plan Benefits.
• Two pairs of glasses in lieu of bifocals.
• Replacement of spectacle lenses, frames, and/or contact lenses furnished under this plan that are lost or damaged, except at the normal intervals when services are otherwise available.
• Medical or surgical treatment of the eyes.
• A service which is not listed under the Schedule of Eye Care Services found in the certificate. Members pay costs exceeding plan benefits.

EyeMed Vision Limitations and Exclusions

What is not covered?

Covered expenses will not include and no benefits will be payable for:

• Vision examinations, lenses and frames more than the frequency as indicated on the plan summary page.
• Orthoptics or vision training and any associated supplemental testing.
• Plano lenses (lenses with refractive correction of less than plus or minus .50 diopter) except as specifically allowed in the frames benefit section of the Plan Benefits.
• Two pairs of glasses in lieu of bifocals.
• Replacement of spectacle lenses, frames, and/or contact lenses furnished under this plan that are lost or damaged, except at the normal intervals when services are otherwise available.
• Medical or surgical treatment of the eyes.
• A service which is not listed under the Schedule of Eye Care Services found in the certificate. Members pay costs exceeding plan benefits.

Indemnity Vision Limitations

Covered expenses will not include and no benefits will be payable for:

• Vision examinations, lenses and frames more than the frequency as indicated on the plan summary page.
• Examinations performed or frames or lenses ordered before the Insured was covered under this section.
• Any examination performed or frame or lens ordered after the Insured's coverage under this section ceases, subject to Extension of Benefits.
• Sub-normal vision aids; orthoptic or vision training or any associated testing.
• Non-prescription lenses.
• Replacement or repair of lost or broken lenses or frames except at normal intervals.
• Any eye examination or corrective eyewear required by an employer as a condition of employment.
• Medical or surgical treatment of the eyes.
• Any service or supply not shown on the Schedule of Eye Care Services.
• Coated lenses; oversize lenses (exceeding 71 mm); photo-gray lenses; polished edges; UV-400 coating and facets, and tints other than solid.
• Lenses and frames during the first twelve months that a person is insured under this section, when the person is a Late Entrant, as defined.

Important State Notices

Fraud Notices

Review your policy carefully
In several states, we are required to advise you of the following: Any person who knowingly and with intent to defraud provides false, incomplete, or misleading information in an application for insurance, or who knowingly presents a false or fraudulent claim for payment of a loss or benefit, is guilty of a crime and may be subject to fines and criminal penalties, including imprisonment. In addition, insurance benefits may be denied if false information provided by an applicant is materially related to a claim. (State-specific statements below.)