Questions & answers · Dental insurance
What does United of Omaha Life Insurance Company's dental insurance policy say about cancelling and getting a refund?
AI-drafted from filed documents · reviewed: pendingcancellation and refundsUnited of Omaha Life Insurance Company
Under United of Omaha Life Insurance Company’s filed form for South Dakota (SD), if the company pays more benefits than it should have, it has the right to a refund from the insured or the recipient of benefits [1]. The company must provide 30 days’ written notice before seeking recovery, identifying the claim and reason for recovery [1]. Recovery is not initiated more than 12 months after the original payment date unless fraud or intentional misconduct occurred [1]. The company may also seek a refund for payments due to fraud, misrepresentation, errors in claim processing, or incomplete information provided by the insured or agent [1]. The insured must reimburse the full amount, and the company cannot reduce current claims for prior overpayments unless fraud or intentional misconduct is involved [1]. The company may offset future benefits to recover overpayments [2]. 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] United of Omaha Life Insurance Company · SD · SERFF MUTM-133715589 · form GDEN2017C AK · p. 26 · 57.1 · REFUND TO US
REFUND TO US If it is found that we paid more benefits than we should have paid under the Policy, we will have the right to a refund from you or the recipient of benefits. We will give 30 days written notice before seeking recovery of an overpayment. The notice will identify the claim and reason for recovery. We will not initiate recovery of an overpayment more than 12 months after the date of original payment, unless there is fraud or intentional misconduct on the part of the provider or Insured. We also have a right to a refund for any payments due to: a) fraud or misrepresentation; b) any error we make in processing a claim; c) you or your agent’s failure to provide complete information; or d) you or your Dependent not being eligible for coverage. You or the recipient of benefits must reimburse us in full. We may not reduce the payment on a current claim for overpayment of a previous claim unless there is fraud or intentional misconduct or reduce the amount allowed on any other claims. If it is found that we paid less benefit than we should have paid under the Policy, we will make additional payments, as necessary.
[2] United of Omaha Life Insurance Company · WV · SERFF CLTR-126253094 · form 7023PC-DEN-EZ 09 · p. 2 · 2.10 · Claim Forms
] Benefits not paid to the Provider shall be paid to You except that benefits unpaid at Your death may be paid, at Our option, to: a) any relative who We determine is entitled to the benefits; or b) Your estate. Any payment made in good faith will fully discharge Us to the extent of the payment.] Refund to Us for Overpayment of Benefits If We pay benefits for Expenses incurred by You [and/or Your Dependent], and it is found that We paid more benefits than We should have paid under the Policy, We will have the right to a refund from You. The amount of the refund is the difference between: a) the amount of benefits paid by Us for those Expenses; and b) the amount of benefits which should have been paid by Us for those Expenses. However, at Our option, We may recover the excess amount by reducing or offsetting any future benefits payable for Expenses incurred by You [and Your Dependent(s)] by the amount of the overpayment.
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 Q65e92f58. Spotted an error? Tell us.