USA Access I (Dental 360)

Many individuals lose their jobs due to company relocations, downsizing, or as the result of natural disasters. For most individuals, loss of employment also means a monetary loss. The Benefits Protector program helps cushion the impact of economic downturns that occur. Should you lose your job through no fault of your own, we will be there for you. Your membership dues will be waived and your membership benefits will continue for three (3) months.*

* Certain terms and conditions apply.

 

USA+ is committed to the promotion of equal access to health care for all Americans. In order to ensure equal access to health care, it is important that there are sufficient medical providers available to serve the public. For that reason, USA+ developed a scholarship program. This program will provide scholarships to outstanding high school seniors that show promise of continued academic performance. This program is only available to dependent children and grandchildren of USA+ members and will allow deserving students to attain their educational goals.

 

HOW YOU BENEFIT

 

CLC ID Protect Plus offers a comprehensive identity protection program with several layers of defense. ID Monitoring is the first layer; however, monitoring will never capture all fraudulent transactions. CLC ID protect backs up monitoring with additional layers of ID Protection and ID Recovery. We add up to $25,000 of insurance coverage to protect against financial losses, a US based team of professional Fraud Resolution Specialists™ to clear your records, tax fraud specialists to help clear issues with the IRS, financial specialists to help resolve financial hardships that can result from identity theft, and finally, we provide discounted legal services should the issue require the intervention of an attorney.
ID Monitoring*
CLC ID Protect Plus includes continuous 24/7 Social Security Number and Personal Information Monitoring with text and email alerts that notify you of possible misuse of your SSN and personal information and suspicious activity. ID Monitoring is a vital component in defending your most valuable asset, your identity.
*CLC ID Protect Plus does not monitor all transactions at all businesses. No service can stop all identity theft events.
ID Protection
CLC ID Protect Plus uses email and text alerts to notify you of suspicious activity involving your SSN and personal information. If your identity is stolen you will receive up to $1,000 in identity theft insurance† coverage available for fraud-related losses and expenses, such as lost wages or legal expenses.
† Identity Theft Insurance underwritten by insurance company subsidiaries or affiliates of American International Group, Inc. (AIG). The description herein is a summary and intended for informational purposes only and does not include all terms, conditions and exclusions of the policies described. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions.
ID Theft Recovery
CLC ID Protect Plus gives you unlimited access to a US based team of Fraud Resolution Specialists™ who work relentlessly on your behalf to restore your stolen identity and repair your damaged credit reputation should you ever fall victim to identity theft.
FRAUD RESOLUTION TEAM
You have unlimited access to our team of Fraud Resolution Specialists™. Each FRS™ is an experienced fraud representative and has been trained under the Fair Credit Reporting Act (FCRA). Each FRS is educated on and familiar with prohibited “collection” company activities under the Fair Debt Credit Protection Act (FDCPA).
Additional certifications include Certified Identity Theft Risk Management Specialist® and Certified Credit Report Reviewer.
EMERGENCY RESPONSE KIT
Receive a step-by-step guide when you fall victim to theft or a breach. This kit is available at any time through our website.

This benefit entitles you to:

• No initial consultation fee.
• One 30-minute in-office visit per month.
• Preparation of a simple Will or review of an existing Last Will and Testament at no charge.  (one per membership)

Plan Details: $70 Annual Deductible for all services, $2,500 annual maximum. Benefits are paid based on the PPO contracted fee. There is no waiting period. Choose any dentist nationwide or select from one of nearly 414,000 provider access locations.

Find a Provider

Benefits are payable as follows:

	Year 1	Year 2	Year 3
Type 1	80%	90%	100%
Cleanings, Exams, Sealants, Fluoride
Type 2	60%	80%	100%
Limited Oral Evaluation, All X-Rays, Palliative Treatment, Professional Consult
Type 3	10%	25%	40%
Endodontics, All Periodontics, Major Restorative, Anesthesia, Complex Extractions
Type 4	25%	50%	75%
Fillings, Crown and Denture Repair, Simple Extractions, Restorative Amalgams and Composites

Incentive Coinsurance: Incentive Coinsurance: All members will begin at the lowest coinsurance level. Members will advance to year two coinsurance level only if a claim is received in the first Benefit Period. Members will advance to year three coinsurance level only if a claim is received in the second Benefit Period.  If a claim is not received, members return to the lowest level of coinsurance. The first Benefit Period begins on the effective date of the membership and ends after 12 months have elapsed. Subsequent Benefit Periods begin on the member’s anniversary date.

Dental Rewards - Rewards insureds that care for their teeth and use only a portion of their annual maximum benefit in a year. With its increasing maximum feature, each insured member and dependent earns additional money toward their next year’s annual maximum.

To get the maximum carryover for the next year, you must meet the following requirements:

1) Visit your Dentist during your 1st Benefit Period.
2) Submit a claim within 180 days of service.
3) Total benefits paid for current benefit year visits must be less than $500.

• If you meet all 3 benefit requirements you will have an additional $250 available in Annual Maximum for the next benefit year.
• In future years, if you have benefits paid of less than $500, additional amounts of $250 will be added to the carryover. However, the most you can accumulate in the maximum carryover is $1,000 per benefit period.
• Your annual maximum will be $3,500 in four years if you continue to visit the dentist once each year

*These insurance benefits are issued on Form Series 9000 Rev.4-13, are underwritten by Ameritas Life Insurance Corp., a NE domiciled life insurance company with main offices located at 5900 O Street, Lincoln, NE 68521. Licensed in all states except NY. This product, and its features are subject to state availability and may vary by state. Certain exclusions and limitations may apply, for cost and complete details of coverage, please contact us or your agent. These insurance benefits are not available in AK, KS, MT, NH, NY, SD, WA and UT.

*Ameritas Life Insurance Corp. (“Ameritas”) provides the Dental and Vision coverage and access to the AXA program. Ameritas does not provide nor is it affiliated with any of the other programs provided as a part of the membership in USA+.

The association membership fee for dental (and vision when applicable) you will be charged includes the following insurance rates, which are paid to  Ameritas: Member Only/ $22.04 Member + 1/ $41.51 Member + Family/$67.22

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

1. for initial placement of any prosthetic crown, appliance, or fixed partial denture unless 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 prosthetic crown, appliance, or fixed partial denture must include the replacement of the extracted tooth or teeth.

2. for appliances, restorations, or procedures to:
a. alter vertical dimension;
b. restore or maintain occlusion; or
c. splint or replace tooth structure lost as a result of abrasion or attrition.

3. for any procedure begun after the insured person’s insurance under this contract terminates; or for any prosthetic dental appliances installed or delivered more than 90 days after the Insured’s insurance under this contract terminates.

4. to replace lost or stolen appliances.

5. for any treatment which is for cosmetic purposes.

6. for any procedure not shown in the Table of Dental Procedures. (There may be additional frequencies and limitations that apply, please see the Table of Dental Procedures for details.)

7. for orthodontic treatment under this benefit provision. (If orthodontic expense benefits have been included in this policy, please refer to the Schedule of Benefits and Orthodontic Expense Benefits provision found on 9260).

8. 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 for profit.

9. for charges which the Insured person is not liable or which would not have been made had no insurance been in force.

10. for services that are not required for necessary care and treatment or are not within the generally accepted parameters of care.

11. because of war or any act of war, declared or not.
 

You receive the following vision benefit: One eye exam once per year per family member from participating providers or $47 towards an exam for non participating providers. There are 37,000 VSP providers and 5,000 retail locations nationwide. Find a VSP provider near you at vsp.com.

*These insurance benefits are issued on Form Series 9000 Rev.4-13, are underwritten by Ameritas Life Insurance Corp., a NE domiciled life insurance company with main offices located at 5900 O Street, Lincoln, NE 68521. Licensed in all states except NY. This product, and its features are subject to state availability and may vary by state. Certain exclusions and limitations may apply, for cost and complete details of coverage, please contact us or your agent. These insurance benefits are not available in AK, KS, MT, NH, NY, SD and UT.

*Ameritas Life Insurance Corp. (“Ameritas”) provides the Dental and Vision coverage and access to the AXA program. Ameritas does not provide nor is it affiliated with any of the other programs provided as a part of the membership in USA+.

The association membership fee for dental (and vision when applicable) you will be charged includes the following insurance rates, which are paid to Ameritas: Member Only/ $22.04 Member + 1/ $41.51 Member + Family/ $67.22

EXCLUSIONS - VISION

This plan does not cover:
· Services and/or materials not specifically included in this Schedule as covered Plan Benefits,
· Plano lenses (lenses with refractive correction of less than plus or minus .50 diopter) except as specifically allowed in the frames benefit section below,
· Services or materials that are cosmetic, including Plano contact lenses to change eye color and artistically painted Contact Lenses,
· Orthoptics or vision training and any associated supplemental testing,
· Medical or surgical treatment of the eyes,
· Local, state and/or federal taxes, except where law requires us to pay

For more information, call USA+ Member Services at 1-800-872-1187 or visit our website at www.usahc.com for online benefit information.

 

 

When our members travel abroad, they will have peace of mind knowing that should a dental or vision need arise, help is just a phone call away. Through AXA Assistance, Ameritas now offers its dental and vision plan members access to dental or vision provider referrals when traveling outside the U.S. AXA Assistance USA is part of a global organization with offices in more than 30 countries, where AXA Assistance professionals answer calls 24 hours a day. Immediately after a call comes in, an assistance coordinator assesses the situation, provides credible provider referrals and can even assist with making the appointment. Within 48 hours following the appointment, the coordinator calls the member to find out if additional assistance is needed. If all is well, the case is closed. Then, the plan member may submit a claim to Ameritas for reimbursement consideration based on applicable plan benefits.

Providers referred by AXA Assistance USA, Inc. (AXA) are not members of the Ameritas Life Insurance Corp. (Ameritas) PPO Network. Referral to an AXA provider is not a guarantee of benefits, and all policy provisions and limitations would apply.

Note: These provider referral assistance services are independently offered and administered by AXA. Ameritas and its affiliates and subsidiaries do not participate in the selection of these dental and vision service providers and do not oversee or monitor AXA’s performance of these services. Additionally, Ameritas does not warrant or guarantee or make any representation as to the quality of the services provided by AXA or by any dental or vision services provider referred by AXA.

Accident Dental Expense

This benefit provides up to $2,000, less a $100 deductible per Injury, for Dental Expenses resulting from an Injury due to an Accident. Each Covered Person is covered for Injury which is incurred on a 24-hour per day basis.

Accidental Death and Dismemberment

Pays the beneficiary up to $1,000 for the member’s death or loss of certain body parts, or loss of sight, speech or hearing, in a covered accident.

These accident insurance benefits are issued on Form Series GP-1400, are underwritten by Guarantee Trust Life Insurance Company, an IL domiciled life insurance company with main offices located at 1275 Milwaukee Ave, Glenview, IL 60025. Licensed in all states except NY. This product, and its features are subject to state availability and may vary by state. Certain exclusions and limitations may apply, for cost and complete details of coverage, please contact us or your agent. These insurance benefits are not available in AK, CO, FL, KS,  MA, MD, MN, MO, MT, NH, NM, NY, RI, SD, UT, and WA.

Guarantee Trust Life Insurance Company (GTL) provides the Accident Medical Expense Benefits coverage and the Accidental Death and Dismemberment, Loss of Sight, Speech and Hearing Benefit coverage. GTL does not provide nor is it affiliated with any of the other programs provided as a part of the membership in USA+.

The association membership fee you will be charged includes the following insurance rates, which are paid to GTL: Member Only/ $.55 Member + 1/ $1.11 Member + Family/$ 1.66

EXCLUSIONS

The Policy does not provide benefits for:

• Treament, services or supplies which:
• Are not specifically listed as Covered Charges in the Policy.
• Are received from persons employed or retained by any Family Member, unless otherwise specified; or
• Are received without charge or legal obligation to pay;
• Are determined to be Experimental/Investigational in nature;
• Are not prescribed by a Doctor as necessary to treat an Injury;
• Are not Medically Necessary;
• Injury by acts of war, whether declared or not.
• Injury received while traveling or flying by air, except as a fare-paying passenger and not as a pilot or crew member, on a regularly scheduled commercial airline.
• Injury covered by Worker’s Compensation, Employer Liability law or Occupational Disease Act or Law.
• Dental treatment, except as specifically stated.
• Injury sustained while committing or attempting to commit a felony.
• Suicide or attempted suicide while sane or insane.
• Intentionally self-inflicted Injury.
• Loss resulting from being legally intoxicated or under the influence of alcohol as defined by the laws of the state or jurisdiction in which the Injury occurs.
• Loss resulting from being under the influence of any drugs or narcotic unless administered on the advice of a Doctor.
• Injury which occurs while a Covered Person is on active duty service in any armed forces. Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.
• Injury sustained flying in an ultra-light, hang gliding, parachuting or bungee-cord jumping, by flight in a space craft or any craft designed for navigation above or beyond the earth’s atmosphere.
• Injury sustained while driving or riding on vehicles for off-road use including but not limited to all-terrain vehicles (ATV’s).
• Injury sustained where a Covered Person is the operator and does not possess a current and valid motor vehicle operator’s license, except in a Driver’s Education Program.
• Treatment in any Veteran’s Administration or federal Hospital, except if there is a legal obligation to pay.
• Cosmetic surgery, except for reconstructive surgery on an injured part of the body.
• Covered Charges incurred outside of the United States or its possessions.
• Competing in motor sports races or competitions;
• Competing in water sports races or competitions;
• Testing cars/trucks on any racetrack or speedway;
• Handling, storing or transporting explosives;
• Scaling up cliffs or mountain walls;
• Spelunking (exploring caves);
• Handling or working with dangerous animals.
• Injury sustained while participating in a rodeo.
• Re-injury or complications of an Injury caused by or contributed to by a condition that existed before the Accident.
• Injury to teeth which is caused from biting, chewing or grinding teeth.
• Injury to teeth with gross decay or advanced periodontal disease;
• Orthodontic therapy to correct a condition that existed prior to the Accident.
• Injury to teeth not firmly attached to the maxilla and/or mandible immediately prior to the  time of the Accident;
• Dental treatment and services performed or supplies used in conjunction with but not due to the covered Accident.