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It is the belief of ADMS and its providers that the Schedule of Benefits
Include Those services that are usual and customary for the normal
are of a patient. The Schedule of Benefits is not intended to represent
all of the available dental Procedures.
For those services not listed on the ADMS Schedule of Benefits, the
Dentist May charge his/her Usual and Customary fee, less 25%. There
are certain procedures listed that a General Dentist may not perform.
In these situations you will be asked to visit with one of our Specialists.
In the event that you are referred to an ADMS preferred Specialist (Oral
Surgeon, Periodontist, Pedodontist, Endodonist, Prosthodontist) you will
be extended a fee which is 25% less that their usual and customary fee.
You will not receive the ADMS reduced fees should you visit a General
Dentist or Specialist who is NOT part of our Panel of Providers.
In the event that you are outside the service area and an emergency
should arise, ADMS will pay up to $ 55.00 for an emergency visit until
you can return to our area. This benefit is limited to one such
occurrence per year. Receipts are required as proof of service.
Members dependent children must be unmarried, less than 19 years of
age (less than 25, if a full-time student), and dependent upon member
for primary support. "Children" includes natural children, stepchildren
residing with the member, legally adopted children, and children subject
to legal guardianship.
The ADMS dental plan may be coordinated with most group insurance
plans. However, the ADMS plan will be considered the secondary plan
only. Consequently, the ADMS member will be expected to pay the
difference between the primary carrier's fee and the ADMS co-payment.
However, this difference cannot exceed the ADMS co-payment amount.
Terminations
If the Member fails to honor the provisions of the Service Agreement as stated on the enrollment form, the member
and all dependents will be terminated effective the last day for which that member's fee has been paid.
Exclusions and Limitations
The following services are not covered by the ADMS Dental Plan.
- Treatment for malignancies, neoplasm's or any other item and service which are not reasonable and necessary for the dental diagnosis and/or treatment as determined by the Member's Dental Provider.
- Services for which a Dental Provider feels is beyond his/her ability or training. In this situation, the patient can be referred to another dentist or physician with special training in that area, with no financial obligation to be borne by the Dental Provider or A.D.M.S.
- Losses covered by Worker's Compensation.
Professional Service Representative
If you should have any questions regarding your membership, coverage, dental care or services, please call our Professional
Service Representative. Our representative is available to help you with any problem you may encounter.
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