Questions & answers · Dental insurance
What events does Alpha Dental Programs, Inc.'s filed dental insurance policy say it pays for?
AI-drafted from filed documents · reviewed: pendingwhether a specific event is coveredAlpha Dental Programs, Inc.
Alpha Dental Programs, Inc.'s filed dental insurance policy in Maryland (MD) states that the company agrees to provide the benefits described in the Schedules and any riders or attachments to the Evidence of Coverage (EOC), subject to the contract terms [1]. The specific benefits covered are detailed in the Schedules and EOC, which are incorporated by reference [1]. In Kentucky (KY), the policy states that the company will pay allowable claims for Covered Orthodontic Services within thirty (30) days following receipt of all necessary claim documentation, or as otherwise required by state law [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] Alpha Dental Programs, Inc. · MD · SERFF DDPA-132784916 · form MC-ALPHA-MD-21 · p. 1 · 2 · Introduction
Introduction Contractholder has applied for a group dental service contract with Alpha Dental Programs, Inc. (“Company”), on behalf of itself, and its affiliated companies, on the following terms: Contractholder will pay Us or Our Third Party Administrator (“Administrator”), the Premiums as shown on the Group Information section. Upon acceptance of the Contractholder’s signed application and in consideration of payment of the first month’s Premium, the term of this Contract will begin at 12:01 a.m. Standard Time on the Effective Date shown on the Group Information section and end on the Contract Term date at 12:00 a.m. Standard Time. In consideration of payment of all Premium shown in the Group Information section, We agree to provide the Benefits described in the Schedules and any riders or attachments to the Evidence of Coverage (“EOC”) subject to the Contract terms. The EOC and Schedules are attached and incorporated herein by reference. The parties will fulfill the obligations stated herein. Terms such as “We,” “Us” and “Our” refers to the Company or Our third party administrator. Additional terms have specific meanings and are described in the Definitions section of this Contract and the EOC. This Contract is issued and delivered in Maryland and is governed by its laws.
[2] Alpha Dental Programs, Inc. · KY · SERFF DDPA-133021223 · p. 5 · 7.2 · COMPENSATION
Company will pay allowable claims for Covered Orthodontic Services within thirty (30) days following Company’s receipt of all necessary claim documentation, or as otherwise required by state law. 3.4 Prohibition Against Enrollee Billings and Collections. Orthodontist agrees that in no event, including Company’s failure to pay Orthodontist because of insolvency or breach of this Agreement, shall Orthodontist bill, charge, collect a deposit, seek compensation, remuneration, or reimbursement from, or have any recourse against any persons other than Company, including, Enrollee or persons acting on their behalf, for Covered Orthodontic Services provided pursuant to this Agreement. This provision shall not prohibit collection of supplemental charges or copayments according to the terms of the DeltaCare USA Plan. Orthodontist further agrees that this Section 3.4 shall survive termination of this Agreement regardless of the cause giving rise to termination, shall be construed to be for the benefit of the Company or Enrollee, and shall supersede any oral or written contrary agreement now existing or hereafter entered into between Orthodontist and Enrollee or persons acting on their behalf.
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 Q7c4dfa35. Spotted an error? Tell us.