Questions & answers · Dental insurance
How does Companion Life Insurance Company's dental insurance policy define a pre-existing condition?
AI-drafted from filed documents · reviewed: pendingpre-existing conditionsCompanion Life Insurance Company
Under Companion Life Insurance Company's filed form DTC FAM PPO CO 2015, Covered Expenses will not include and no benefits will be payable for Class III Procedures in the first 3 months that the insured is covered under this plan, except when the prior plan replaced the insured’s coverage, contained similar benefits for Class III Procedures as this plan, had been in effect for at least 18 months, and takeover benefits have been approved by Companion Life [1]. For Late Entrants, benefits are not payable in the first twelve months of coverage, except for exams, cleanings, and fluoride application [1]. This does not appear in these excerpts — check the full policy.
Information only — not legal advice. The insurer decides.
These answers quote forms insurers filed with state regulators. Your own policy, its endorsements and your state’s rules control. A filed form may not be the version sold to you.
Where this comes from (2)
[1] Companion Life Insurance Company · CO · SERFF ICCI-129544865 · form DTC FAM PPO CO 2015 · p. 18 · 43.1 · Section 8 – Limitations/Exclusions (What is Not Covered
Section 8 – Limitations/Exclusions (What is Not Covered and Pre-Existing Conditions [I. Covered Expenses will not include and no benefits will be payable: 1. [for Class III Procedures in the first 3 months that the insured is covered under this plan except: a. when this plan replaces the insured’s coverage under the employer’s prior; b. the prior plan contained similar benefits for Class III Procedures as this plan; c. the prior plan had been in effect for at least 18 months; and d. takeover benefits have been approved by Companion Life.] 2. in the first twelve months that a person is insured if the person is a Late Entrant, except as provided in this Policy; except for exams, cleanings and fluoride application. Does not apply to pediatric essential health benefits. … (excerpt — the filed text continues)
[2] Companion Life Insurance Company · CO · SERFF CMLX-130570134 · form DTC PPO 2016 CO · p. 6 · 32 · SECTION 7 – BENEFITS/COVERAGE (WHAT IS COVERED)
SECTION 8 – LIMITATION/EXCLUSIONS (WHAT IS COVERED AND PRE-EXISTING CONDITIONS) SECTION 9 – INSURED PERSON PAYMENT RESPONSIBILITY SECTION 10 – CLAIMS PROCEDURES (HOW TO FILE A CLAIM) SECTION 11 – GENERAL CERTIFICATE PROVISIONS SECTION 12 – TERMINATION/NONRENEWAL/CONTINUATION SECTION 13 – APPEALS AND COMPLAINTS SECTION 14 – INORMATION ON POLICY AND RATE CHANGES SECTION 15 – DEFINITIONS SECTION 5 - ELIGIBILITY Eligible Employee means Active Full-Time Employees working [30] hours or more per week who are legal residents or citizens of the U.S., excluding temporary and seasonal employees and Retirees. Eligible Employees do not include Employees or Dependents enrolled in a dental plan in a federal or state Health Insurance Marketplace. … (excerpt — the filed text continues)
Drafted by a local AI model from the excerpts above, then checked by rules (citations, no rankings, no “not covered” claims from a partial excerpt). Question id Qa7e35a12. Spotted an error? Tell us.