Coordination of Benefits

Get Anthem Virginia Individual or Family dental Quotes

Anthem Blue Cross and Blue Shield policies all have a coordination of benefits provision. This provision explains that if you are issued an Anthem Blue Cross and Blue Shield Individual Dental Plan policy, and one of the persons covered by your Anthem policy is covered by a dental group plan, the dental group plan will have primary responsibility for the covered expenses of that family member. For any dependent children on your Anthem individual policy who are enrolled under another individual dental plan, the primary policy is the policy of the parent whose birthday (month and day) falls earlier in the calendar year. Parent birth year is not considered.

Eligibility

Individual Dental Plan coverage is available to those who:

• are under age 65, or 65 and older only if enrolled or enrolling in an Anthem Medicare Supplement plan;
• live in the Anthem Blue Cross and Blue Shield service area; and
• are not eligible for any group dental coverage.

Your spouse and dependent children are also eligible to apply. Dependent children must be:

• unmarried;

under age 19 (or 23 if a full-time student); and

not on active duty with any branch of the armed services.

This individual dental policy cannot be used as an employer-provided dental benefit plan. No employer of any person covered under this policy may pay any premium for this coverage, directly or indirectly, including through wage adjustment. “Employer” does not include a trade or business wholly owned by an individual, or individual and spouse, that has no other employees or that does not offer dental benefits to any other employees. Also, as it pertains to this provision, a church may purchase an individual dental policy if only purchasing it for one employee.

Renewability

Your policy is automatically renewed at the option of the Insured, as long as:

• premiums are paid in accordance with the terms of the policy;
• there is no documented pattern of abuse or misuse of our network by you;
• you make no fraudulent or material misrepresentation under the terms of this

coverage, including on your application; and

• the Insured resides in Anthem's service area.

We can refuse to renew this policy if all policies of the same form number are also not renewed. Any such action will be in accordance with applicable state and Federal laws.

Application fee

When you apply for Anthem Individual Dental, you must pay a $25 application fee which is non-refundable upon termination of your application or policy.

Canceling your policy

If you wish to cancel your policy, you must tell us by phone or in writing. Other than the application fee described above, we'll refund any unused premium within 31 days after the cancellation date. Once you cancel your coverage, you cannot reapply for this coverage until 24 months after cancellation or lapse of this policy.

Termination

Coverage ends for a covered spouse upon divorce from the covered person in whose name the dental program was obtained (the Insured). Coverage will end for covered persons:

• if the required Premium is not paid when due, subject to a 31-day grace period;
• if there is a documented pattern of abuse or misuse of our dental network;
• at the Insured's request;
• at the Insured's death (a covered spouse or dependent may continue coverage under the dental program as long as the spouse or dependent contacts us within 31 days of the Insured's death to arrange for continued coverage); or
• when he/she begins active duty with the armed services;

In addition, coverage ends for dependent children:

If the covered child is incapable of earning a living because of a mental or physical handicap, coverage for the child will continue as long as the Insured's coverage is in force.