|
JUST
WHAT YOUR FAMILY NEEDS
|
|
Plan
Not Available in:
LA, ME, MA, MT, NV, NY, NC, OR, UT or WA |
| Essential Dental
Solutions Plan covers the services your family
needs for good oral health! It is affordable
because it focuses on providing the benefits
that you and your family need to maintain good
oral health, not on benefits you may never
use! |
| Everyone is
accepted and there are no deductibles or
benefit waiting periods, so you and your
family can start using the dental benefits as
soon as the policy becomes active. |
| The
Dental Plan provides access to 85,000
credentialed dentists nationwide. |
|
|
| |
| Covered
Service |
In
Network Benefit |
Benefit
Guidelines |
| Preventative
& Diagnostic Services |
| Periodic
Oral Exam (Office Visit) |
100%* |
Twice
per year*** |
| Prophylaxis
(Teeth Cleaning) |
100%* |
Twice
per year*** |
| Bitewing
X-Rays |
100%* |
One
set every year*** |
| Full
Mouth X-Rays |
Discount
(Average 42%)** |
|
| Basic
Services |
| Resin-Based
Composite (Filling) |
100%* |
One
filling per year (one surface)*** |
| Additional
Fillings |
Discount
(Average 32%)** |
|
| Major
Services |
| Root
Canals |
Discount
(Average 34%)** |
|
| Surgical
Extractions |
Discount
(Average 31%)** |
|
| Crowns |
Discount
(Average 27%)** |
|
| Upper
Denture |
Discount
(Average 48%)** |
|
| Orthodontia |
Discount
(Average 20%)** |
|
|
|
| OTHER
PLAN PROVISIONS |
| Annual
Deductible |
None |
| Benefit
Waiting Periods |
None |
| Annual
Benefit Maximum |
$500
per listed family member |
|
|
| Click
Here for Examples on
Savings for Discounted Procedures |
|
| The
Essential Dental Solutions program may not be available in all
states. |
| |
| The Dental
Plan is provided through a group policy issued to the National
Congress of Employees Association located in Washington, D.C.
This affordable Dental Plan is administered by Group Dental
Service, a company that has been providing quality dental
plans and services for over 42 years. |
|
| *Members
can receive benefits from any provider! However, benefits are
calculated using a Maximum Allowable Charge. Maximum Allowable
Charges are limitations on billed charges and are based on
fees paid to Network Providers in the geographic area where
the expenses are incurred. For Out of Network Providers,
members are responsible for amounts charged by the provider
that exceed benefits, and may be required to remit payment at
the time of service. |
|
| **Active
Members will enjoy discounts, on average 20% to 50% off
standard fees, on other covered dental procedures when you see
a participating Network Provider. Members who see an Out of
Network Provider will not be entitled to a discount. Discounts
will vary by provider and location. |
|
| ***The
Benefit Guidelines are for each listed family member and the
benefits cannot be transferred or combined between members. |
| |
| Notices: |
|
| To be
eligible to receive these insurance benefits all members must
be an active dues paying member of National Congress of
Employees Association (NCE). This insurance plan is
underwritten by National Guardian Life Insurance Company, NAIC
# 66583, domiciled in Wisconsin with their principal place of
business located at 2 East Gilman St., Madison, WI 53703, and
is licensed in Washington D.C. National Guardian Life is not
affiliated with The Guardian Life Insurance Company of
America, aka The Guardian or Guardian Life. These benefits are
provided under the Group Dental Policy (Policy Form NDNGRP
04/06) issued to the NCE and are subject to the exclusions,
limitations, terms and conditions of coverage as set forth in
the Certificate of Insurance. The insurance premiums for these
benefits are paid by NCE out of membership fees collected. The
membership fees charged for this program are not insurance
premiums. The dental product may vary by State and may not be
available in all States. |
|
| |
| NCEA
Membership Benefits |
|
| 1. |
Essential
Dental Solutions |
| 2. |
Dental
Financing |
| 3. |
Prescription
Drug Program - Walk-In |
| 4. |
Prescription
Drug Program - Mail Order |
| 5. |
World
Wide Assistance |
| 6. |
Vitamins
& Supplements Discounts |
| 7. |
Hearing
Program |
| 8. |
FTD
Flowers Discounts |
| 9. |
Car and
RV Rental Discounts |
| 10. |
Automotive
Discounts |
| 11. |
Real
Estate Rebate |
| 12. |
Discount
Cruises |
| 13. |
Theme
Park Discounts |
| 14. |
Dining,
Entertainment & Travel Discounts |
|
| The
Essential Dental Solutions program may not be available in all
states. |
| |
| Disclosures |
|
- THIS MEMBERSHIP DOES NOT
INCLUDE A HEALTH INSURANCE POLICY
- This membership plan
provides discounts at certain health care providers for
dental services.
- This membership plan does
not make payments directly to the providers of medical
services.
- Each Member and their family
members are obligated to pay for all dental care services
they receive that exceed the Annual Benefit Limit but will
receive a discount from those health careproviders who
have contracted with the Association’s Dental Insurance
Provider.
|
| |
| For a full
explanation of your dental benefits provided through the NCE
Association, please click
here. |
|
|
| Form:
EDSGAC_027 |
| |
| |
 Back |
| Benefits
Details |
| |
| Your NCEA
Membership Benefits |
|
| 1. |
Essential
Dental Solutions |
| 2. |
Dental
Financing |
| 3. |
Prescription
Drug Program - Walk-In |
| 4. |
Prescription
Drug Program - Mail Order |
| 5. |
World
Wide Assistance |
| 6. |
Vitamins
& Supplements Discounts |
| 7. |
Hearing
Program |
| 8. |
FTD
Flowers Discounts |
| 9. |
Car and
RV Rental Discounts |
| 10. |
Automotive
Discounts |
| 11. |
Real
Estate Rebate |
| 12. |
Discount
Cruises |
| 13. |
Theme
Park Discounts |
| 14. |
Dining,
Entertainment & Travel Discounts |
|
| |
| Covered
Service |
In
Network Benefit |
Benefit
Guidelines |
| Preventative
& Diagnostic Services |
| Periodic
Oral Exam (Office Visit) |
100%* |
Twice
per year*** |
| Prophylaxis
(Teeth Cleaning) |
100%* |
Twice
per year*** |
| Bitewing
X-Rays |
100%* |
One
set every year*** |
| Full
Mouth X-Rays |
Discount
(Average 42%)** |
|
| Basic
Services |
| Resin-Based
Composite (Filling) |
100%* |
One
filling per year (one surface)*** |
| Additional
Fillings |
Discount
(Average 32%)** |
|
| Major
Services |
| Root
Canals |
Discount
(Average 34%)** |
|
| Surgical
Extractions |
Discount
(Average 31%)** |
|
| Crowns |
Discount
(Average 27%)** |
|
| Upper
Denture |
Discount
(Average 48%)** |
|
| Orthodontia |
Discount
(Average 20%)** |
|
|
| |
| OTHER
PLAN PROVISIONS |
| Annual
Deductible |
None |
| Benefit
Waiting Periods |
None |
| Annual
Benefit Maximum |
$500
per listed family member |
|
|
| Click
Here for Examples on
Savings for Discounted Procedures |
|
| The
Essential Dental Solutions program may not be available in all
states. |
| |
| The Dental
Plan is provided through a group policy issued to the National
Congress of Employees Association located in Washington, D.C.
This affordable Dental Plan is administered by Group Dental
Service, a company that has been providing quality dental
plans and services for over 42 years. |
|
| *Members
can receive benefits from any provider! However, benefits are
calculated using a Maximum Allowable Charge. Maximum Allowable
Charges are limitations on billed charges and are based on
fees paid to Network Providers in the geographic area where
the expenses are incurred. For Out of Network Providers,
members are responsible for amounts charged by the provider
that exceed benefits, and may be required to remit payment at
the time of service. |
|
| **Active
Members will enjoy discounts, on average 20% to 50% off
standard fees, on other covered dental procedures when you see
a participating Network Provider. Members who see an Out of
Network Provider will not be entitled to a discount. Discounts
will vary by provider and location. |
|
| ***The
Benefit Guidelines are for each listed family member and the
benefits cannot be transferred or combined between members. |
| |
| Disclosures |
|
- THIS MEMBERSHIP DOES NOT
INCLUDE A HEALTH INSURANCE POLICY
- This membership plan
provides discounts at certain health care providers for
dental services.
- This membership plan does
not make payments directly to the providers of medical
services.
- Each Member and their family
members are obligated to pay for all dental care services
they receive that exceed the Annual Benefit Limit but will
receive a discount from those health careproviders who
have contracted with the Association’s Dental Insurance
Provider.
|
| |
|
|
| |
| |
| Back |
| NCEA
Benefits and Terms |
| |
| NCEA
Benefits |
|
| NCEA
Membership Benefits |
| 1. |
Essential
Dental Solutions* |
| 2. |
Dental
Financing |
| 3. |
Prescription
Drug Program - Walk-In |
| 4. |
Prescription
Drug Program - Mail Order |
| 5. |
World
Wide Assistance |
| 6. |
Vitamins
& Supplements Discounts |
| 7. |
Hearing
Program |
| 8. |
FTD
Flowers Discounts |
| 9. |
Car and
RV Rental Discounts |
| 10. |
Automotive
Discounts |
| 11. |
Real
Estate Rebate |
| 12. |
Discount
Cruises |
| 13. |
Theme
Park Discounts |
| 14. |
Dining,
Entertainment & Travel Discounts |
|
| *The
Dental Plan is provided through a group policy issued to the
National Congress of Employees Association located in
Washington, D.C. This affordable Dental Plan is administered
by Group Dental Service, a company that has been providing
quality dental plans and services for over 42 years |
|
| |
| NCEA
TERMS AND CONDITIONS |
|
| Membership
Agreement in the National Congress of Employees Association (NCE) |
|
| If you have any
questions regarding your purchase, please call or write: |
| Recruiting
Organization: |
|
Essential
Dental Solutions LLC
P.O. Box 1959
Moorpark, CA 93020
1-800-231-2714 |
|
By joining The
NCE, you are agreeing to adhere to the constitution and
by-laws of the association and understand that you are
purchasing a membership in The NCE. Once you become a member
any and all member benefits are provided at no cost to the
member and vary by the Level of Membership you have selected.
By becoming a member you are authorizing the RECRUITING
ORGANIZATION listed above to bill your credit card or checking
account for your membership fees. This charge shall remain in
force until you notify RECRUITING ORGANIZATION of its
cancellation. By becoming a member in the NCE, you acknowledge
NCE’s terms and conditions of membership herein. This
membership will automatically renew at the end of your
membership term on a monthly basis, and your credit card or
checking account will be automatically debited for your
monthly fees. If you wish to change your payment method,
please contact RECRUITING ORGANIZATION at the number indicated
above.
TERMINATION: The NCE
reserves the right to terminate the Membership of any Member
or Member’s dependents or deny eligibility to any person for
any reason, including for a Member’s failure or refusal to
pay a participating provider of service, or for nonpayment of
membership fees payable to RECRUITING ORGANIZATION when due.
CANCELLATION POLICY: Please
call the RECRUITING ORGANIZATION to terminate or cancel your
membership and to automatically revoke your permission to
continue any further payments. This membership can be
cancelled for non payment of any amount due.
REFUND POLICY: If you
cancel for any reason within the first thirty (30) days of
membership, you will receive a full refund of the membership
fee. The one-time registration and shipping fees as disclosed
are non-refundable.
DESCRIPTION OF BENEFITS: Please
refer to your fulfillment materials for a full description of
benefits.
ADD OR UPDATE INFORMATION: If
you would like to update information for you or your
dependants, please call Customer Service at 866-709-8502.
COMPLAINT PROCEDURE: If
you would like to file a complaint, please call Customer
Service at 866-709-8502. |
|
| DISCOUNTS
AND SAVINGS ARE NOT INSURANCE BENEFITS. |
| |
| |
| Back |
| Exclusions
and Limitations |
| |
| LIMITATIONS,
EXCLUSIONS & EXCEPTIONS |
|
| Neither the
RECRUITING ORGANIZATION, the Association nor Administrator are
licensed insurers, health maintenance organizations, discount
medical provider organizations or underwriters of health care
services. No portion of any provider’s fees will be
reimbursed or otherwise paid by the RECRUITING ORGANIZATION or
the Administrator. |
|
| DISCOUNT
MEDICAL BENEFITS ARE NOT INSURANCE: Your membership
may contain certain limited supplemental group coverage
benefits. Members are responsible for payment in full at the
time that medical, legal or other services are provided by
benefit providers that are in excess of the Annual Benefit
Limit. The RECRUITING ORGANIZATION, the Association, the
Administrator, their affiliates, agents, and sales
representatives are not responsible for payment of any kind on
behalf of members of this association. The benefit providers
and Administrators have no liability for providing or
guaranteeing service or the quality of service rendered. |
|
| DISCOUNTS:
This NCE membership makes it possible for members to
receive reduced rates on various products and services through
participating providers. Discounts received cannot be used in
conjunction with any other kind of rate reduction mechanisms.
Discounts are based on the provider’s standard fees. Actual
discounts will vary depending on the place and the specific
services or products purchased. From time to time, certain
providers may offer products or services to the general public
at prices lower than the discounted prices available through
this Association. In such event, members will be charged the
lowest price. |
|
| PROVIDERS:
It is the member’s responsibility to confirm with
Member Services that a provider is an active participant of
the program prior to seeing that provider. The Administrator
reserves the right to add, change, and/or eliminate any of the
service providers included in the Association’s benefits
without prior written notice to the member. It is possible
that a member may not receive a discount on health related
services if they are covered by medical or health insurance or
if the services were initiated prior to the member’s
activation of this membership. |
|
| MEDICAL
TREATMENT: The NCE Association, its affiliates,
agents, Administrator, and sales representatives are not
responsible for providing or failing to provide medical
services, treatments, consultations, diagnosis, or advice to a
member or to a member’s dependents by any service provider.
This program has no liability for providing or guaranteeing
medical services or for the quality of services rendered.
Selecting a service provider is the member’s obligation,
which shall be made at the member’s sole discretion. Such
decision shall not be based on the advice, credentials, or
recommendation of The NCE, its affiliates, agents,
Administrator, or sales representatives. This program does not
practice medicine nor does it interfere, participate nor form
part of the provider-doctor/member-patient relationship. |
|
| SERVICE
AVAILABILITY: This program does not guarantee that
the products, services or facilities are available in every
geographic location within the United States. Not available in
all states, call for availability. |
|
| Utah
Residents: This contract is not protected by the Utah
Life and Health Guaranty Association. |
| Kentucky
Residents: This contract is not an insurance policy
and is not protected by the Kentucky Life and Health Guaranty
Association |
| New York
Residents acknowledge that the savings offered
through the network of providers is subject to the network
contracts applicable to the laws of New York State. |
| Washington
State Residents: Membership nor any limited
supplemental insurance association group policies or their
associated benefits are not available to Washington state
residents. |
| |
| |
| Back |
| FAQ |
| |
| FREQUENTLY
ASKED QUESTIONS |
| |
| Do
I have to choose a dentist? |
| No. You
may select the dentist of your choice. However, you
will receive the highest level of benefits available
by choosing an in-network provider. When you visit a
participating dentist, you have the opportunity to
maximize your benefit plan with access to negotiated
network fees, resulting in lower out-of-pocket expenses. |
| |
| What
is a negotiated network fee? |
| A
negotiated network fee refers to a discounted schedule
that participating in network providers agree to
accept as payment in full for services rendered.
Typical discounts range from approximately 20%-35%.
Depending on the service rendered, your plan may cover
all or part of the discounted fee. |
| |
| How
many dentists are in-network? |
| There
are over 85,000
participating in-network dentists nationwide,
including over 15,000 specialists. So, you should be
able to locate a participating provider in your area,
while traveling, if emergency care is needed, or for
your eligible dependents away at college. All
in-network dentists meet strict credentialing
standards and have agreed to accept negotiated
discounts as payment-in-full (no balance billing) for
covered services rendered. |
| |
| How
do I locate in-network dentists? |
| You can
conduct online provider searches on our website by Clicking
Here, or call our member service
department at 1-866-910-0849. |
| |
| Do
my dependents have to visit the same dentist that I
visit? |
| No, you
and your dependent have the freedom to choose any
dentist, and can switch as many times as you would
like during the policy year. |
| |
| Who
is covered under the Family Plan? |
| Enrolled
members that meet the definition of Family.
“Family” means the Eligible Person, spouse and/or
domestic partner and Child(ren). “Child” includes
natural child, stepchild, foster child, legally
adopted child, a child pending finalization of
adoption proceedings, and an individual placed in the
custody of an Eligible Person as a result of a
guardianship or primary care. ‘Primary care’ means
that the Eligible Person provides food, clothing, and
shelter, on a regular and continuous basis, for the
minor grandchild, niece or nephew during the time that
schools are in regular session. “Eligible Child”
means any unmarried Child(ren) of the Eligible Person
until the end of the calendar month which he/she
reaches age 21; or until the end of the calendar month
which he/she reaches age 23 if a full-time student
(written proof is required). |
| |
| How
do I get reimbursed if I visit an out-of-network
dentist? |
| If you
visit a dentist out-of-network, you are responsible
for paying the entire amount of the dentist’s usual
and customary charge (non-discounted rate) at the time
of service. You must then submit a claim form so that
we may process your claim, determine the Maximum
Allowable Charge and determine if any reimbursement is
payable for the claim. |
| |
| What
other benefits are available to me as a NCE member? |
| There
are many valuable benefits as a NCE member that you
will receive in your fulfillment packet or can preview
on this web site. |
| |
| How
and when do I file a claim? |
| In-network
providers have contractually agreed to file claims for
you. If your dentist does not participate in the
network (out-of-network), you may have to file the
claim yourself. A claim form is included in your
welcome kit, it is also available from your benefits
administrator, or it can be printed from the website
at: www.essentialdentalsolutions.com/claimform .
Remember to bring a claim form with you to your
appointment so your dentist can help you fill it out.
For each claim submission, GDS will expeditiously mail
you a concise explanation of benefits and
reimbursement according to your plan guidelines. |
| |
| For
questions regarding dental benefits or claims, please
call: 1-866-910-0849. |
| |
| Where
should I mail my claim? |
GDS –
Claims Department
PO Box 10949
Rockville, MD 20849 |
| |
|
| |
| |
| Back |
| Security
and Privacy Statement |
| |
When you become
a GACquote.com customer, you entrust us with your personal
data. We consider your data to be private and confidential,
and we hold ourselves to the highest standards of trust and
fiduciary duty in their safekeeping and use.
General Agent Center (GAC) and our partners will not release
information about you or your application, policy or claims
information, unless one or more of the following conditions
are met:
- We receive your prior
written consent.
- We believe the
prospective recipient to be you or your authorized
representative.
- We are required by law
to release information to the recipient.
Questions about your medical
history and physical condition are required by our insurance
carrier partners and will be released to the insurer so that
they may underwrite your insurance application. GAC will not
give or sell information about you to any other company,
individual, or group without your prior authorization.
GAC will only use information about you to help us better
serve your insurance needs or to suggest GAC services or
insurance materials that may be of interest to you.
To further protect your privacy, our web site uses the highest
levels of Internet security, including data encryption, user
names and passwords, and other security tools.
Occasionally, GAC may conduct marketing surveys or research to
help us evaluate products, services, and the changing needs of
our customers. It is GAC's policy to keep this information
confidential.
We will not share individual marketing data gathered from our
web site with individuals or business entities not affiliated
with GAC.
We know that the privacy of your personal information is
important to you. In order to provide you with insurance
products of the highest quality and with the service you
deserve, it may be necessary for us from time to time to
collect nonpublic personal and financial information about you
(the "Information") and, in certain situations, to
share that Information with others. The following notice
describes our policies and practices with regard to your
Information. |
| |
| HOW WE
PROTECT YOUR INFORMATION |
| We maintain
physical, electronic and procedural safeguards to protect the
Information against unauthorized access and use. We restrict
access to the Information to those employees who need access
to provide products and services to you and your dependents.
The personnel who have access are trained in the proper
handling of the Information. Employees who violate this strict
level of confidentiality are subject to our disciplinary
process. |
| |
| CATEGORIES
OF INFORMATION THAT WE COLLECT |
In the normal
course of business we may collect the following types of
Information:
- Information you provide on
applications and other forms (including name and address)
- Data about your transactions
with us (such as types of products you have purchased and
your account status)
- Information gathered on our
Web sites through online forms, site visit data and online
information-collecting devices known as
"cookies"
|
| |
| HOW WE
USE YOUR INFORMATION |
- We may share your
information among the Insurance Companies as permitted by
law, including for routine business administration.
- We may share information
with non-affiliated companies as allowed by law, such as
firms that perform services on our behalf, including the
administration and marketing of our products. We require
these companies to meet strict privacy standards.
- We may disclose information
to non-affiliated entities when required by law, such as
to respond to a subpoena, to prevent fraud or to comply
with an inquiry by a government agency.
|
| |
| ACCURACY
OF YOUR INFORMATION |
| We strive to
maintain the accuracy of Information that is in our possession
about you. In order to help us maintain accuracy, you have the
right to reasonably access your information. If you believe
any information in our possession is inaccurate, a request can
be made to amend or delete the information that you believe to
be erroneous. If we concur with the request, we will amend or
delete the information in question. You may write our Privacy
Office at the address below to receive our complete policy on
accessing and amending the Information. |
| |
| CHANGES
TO THIS NOTICE |
| We reserve the
right to change this Notice. We reserve the right to make the
revised Notice effective for the Information we already have
about you as well as any Information we receive in the future.
If we make any material changes to our policies or practices,
we will provide you with a copy of a revised Notice. We will
post a copy of the current Notice on our websites. The Notice
will contain in the top right-hand corner, the effective date. |
| |
| You may
contact our Privacy Office at: |
General Agent
Center
15575 North 79th Place, Suite 100 Scottsdale, AZ 85260 |
| |
| |
|
