Essential Dental Solutions Plan

ESSENTIAL DENTAL SOLUTIONS PLAN

Questions Please Call 1-800-544-9505

JUST WHAT YOUR FAMILY NEEDS

$34.95 / Month Includes Entire Family

Essential Dental Solutions Plan covers the services your family needs for good oral health! It is affordable because it focuses on providing the benefits that you and your family need to maintain good oral health, not on benefits you may never use!

Everyone is accepted and there are no deductibles or benefit waiting periods, so you and your family can start using the dental benefits right away.

The Dental Plan provides access to 85,000 credentialed dentists nationwide.

Click Here to Search for Providers in Your Area

Covered Service	In Network Benefit	Benefit Guidelines
Preventative & Diagnostic Services
Periodic Oral Exam (Office Visit)	Pays 100%*	Twice per year***
Prophylaxis (Teeth Cleaning)	Pays 100%*	Twice per year***
Bitewing X-Rays	Pays 100%*	One set every year***
Full Mouth X-Rays	Discount (Average 42%)**
Basic Services
Resin-Based Composite (Filling)	Pays 100%*	One filling per year (one surface)***
Additional Fillings	Discount (Average 32%)**
Major Services
Root Canals	Discount (Average 34%)**
Surgical Extractions	Discount (Average 31%)**
Crowns	Discount (Average 27%)**
Upper Denture	Discount (Average 48%)**
Orthodontia	Discount (Average 20%)**

OTHER PLAN PROVISIONS
Annual Deductible	None
Benefit Waiting Periods	None

Click Here for Examples on Savings for Discounted Procedures

The Essential Dental Solutions program may not be available in all states.

The Dental Plan is provided through a group policy issued to the National Congress of Employees Association located in Washington, D.C. This affordable Dental Plan is administered by Group Dental Service, a company that has been providing quality dental plans and services for over 42 years.

*Members can receive benefits from any provider! However, benefits are calculated using a Maximum Allowable Charge. Maximum Allowable Charges are limitations on billed charges and are based on fees paid to Network Providers in the geographic area where the expenses are incurred. For Out of Network Providers, members are responsible for amounts charged by the provider that exceed benefits, and may be required to remit payment at the time of service.

**Active Members will enjoy discounts, on average 20% to 50% off standard fees, on other covered dental procedures when you see a participating Network Provider. Members who see an Out of Network Provider will not be entitled to a discount. Discounts will vary by provider and location.

***The Benefit Guidelines are for each listed family member and the benefits cannot be transferred or combined between members.

Notices:

To be eligible to receive these insurance benefits all members must be an active dues paying member of National Congress of Employees Association (NCE). This insurance plan is underwritten by National Guardian Life Insurance Company, NAIC # 66583, domiciled in Wisconsin with their principal place of business located at 2 East Gilman St., Madison, WI 53703, and is licensed in Washington D.C. National Guardian Life is not affiliated with The Guardian Life Insurance Company of America, aka The Guardian or Guardian Life. These benefits are provided under the Group Dental Policy (Policy Form NDNGRP 04/06) issued to the NCE and are subject to the exclusions, limitations, terms and conditions of coverage as set forth in the Certificate of Insurance. The insurance premiums for these benefits are paid by NCE out of membership fees collected. The membership fees charged for this program are not insurance premiums. The dental product may vary by State and may not be available in all States.

NCEA Membership Benefits

1.	Essential Dental Solutions
2.	Dental Financing
3.	Prescription Drug Program - Walk-In
4.	Prescription Drug Program - Mail Order
5.	World Wide Assistance
6.	Vitamins & Supplements Discounts
7.	Hearing Program
8.	FTD Flowers Discounts
9.	Car and RV Rental Discounts
10.	Automotive Discounts
11.	Real Estate Rebate
12.	Discount Cruises
13.	Theme Park Discounts
14.	Dining, Entertainment & Travel Discounts

The Essential Dental Solutions program may not be available in all states.

Disclosures

THIS MEMBERSHIP DOES NOT INCLUDE A HEALTH INSURANCE POLICY
This membership plan provides discounts at certain health care providers for dental services.
This membership plan does not make payments directly to the providers of medical services.
Each Member and their family members are obligated to pay for all dental care services they receive that exceed the Annual Benefit Limit but will receive a discount from those health care providers who have contracted with the Association’s Dental Insurance Provider.

For a full explanation of your dental benefits provided through the NCE Association, please click here.

Refer a Dentist to the Network

Form: EDSGAC_027

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Benefits Details

Your NCEA Membership Benefits

1.	Essential Dental Solutions
2.	Dental Financing
3.	Prescription Drug Program - Walk-In
4.	Prescription Drug Program - Mail Order
5.	World Wide Assistance
6.	Vitamins & Supplements Discounts
7.	Hearing Program
8.	FTD Flowers Discounts
9.	Car and RV Rental Discounts
10.	Automotive Discounts
11.	Real Estate Rebate
12.	Discount Cruises
13.	Theme Park Discounts
14.	Dining, Entertainment & Travel Discounts

Covered Service	In Network Benefit	Benefit Guidelines
Preventative & Diagnostic Services
Periodic Oral Exam (Office Visit)	100%*	Twice per year***
Prophylaxis (Teeth Cleaning)	100%*	Twice per year***
Bitewing X-Rays	100%*	One set every year***
Full Mouth X-Rays	Discount (Average 42%)**
Basic Services
Resin-Based Composite (Filling)	100%*	One filling per year (one surface)***
Additional Fillings	Discount (Average 32%)**
Major Services
Root Canals	Discount (Average 34%)**
Surgical Extractions	Discount (Average 31%)**
Crowns	Discount (Average 27%)**
Upper Denture	Discount (Average 48%)**
Orthodontia	Discount (Average 20%)**

OTHER PLAN PROVISIONS
Annual Deductible	None
Benefit Waiting Periods	None
Annual Benefit Maximum	$500 per listed family member

Click Here for Examples on Savings for Discounted Procedures

The Essential Dental Solutions program may not be available in all states.

***The Benefit Guidelines are for each listed family member and the benefits cannot be transferred or combined between members.

Disclosures

THIS MEMBERSHIP DOES NOT INCLUDE A HEALTH INSURANCE POLICY
This membership plan provides discounts at certain health care providers for dental services.
This membership plan does not make payments directly to the providers of medical services.
Each Member and their family members are obligated to pay for all dental care services they receive that exceed the Annual Benefit Limit but will receive a discount from those health care providers who have contracted with the Association’s Dental Insurance Provider.

	For a full explanation of your dental benefits provided through the NCE Association, please click here.
	Certificates Of Coverage
	Find a Dentist
	Find a Pharmacy
	Refer a Dentist to the Network

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NCEA Benefits and Terms

NCEA Benefits

NCEA Membership Benefits

1.	Essential Dental Solutions*
2.	Dental Financing
3.	Prescription Drug Program - Walk-In
4.	Prescription Drug Program - Mail Order
5.	World Wide Assistance
6.	Vitamins & Supplements Discounts
7.	Hearing Program
8.	FTD Flowers Discounts
9.	Car and RV Rental Discounts
10.	Automotive Discounts
11.	Real Estate Rebate
12.	Discount Cruises
13.	Theme Park Discounts
14.	Dining, Entertainment & Travel Discounts

*The Dental Plan is provided through a group policy issued to the National Congress of Employees Association located in Washington, D.C. This affordable Dental Plan is administered by Group Dental Service, a company that has been providing quality dental plans and services for over 42 years

NCEA TERMS AND CONDITIONS

Membership Agreement in the National Congress of Employees Association (NCE)

If you have any questions regarding your purchase, please call or write:

Recruiting Organization:

Essential Dental Solutions LLC
P.O. Box 1959
Moorpark, CA 93020
1-800-231-2714

By joining The NCE, you are agreeing to adhere to the constitution and by-laws of the association and understand that you are purchasing a membership in The NCE. Once you become a member any and all member benefits are provided at no cost to the member and vary by the Level of Membership you have selected. By becoming a member you are authorizing the RECRUITING ORGANIZATION listed above to bill your credit card or checking account for your membership fees. This charge shall remain in force until you notify RECRUITING ORGANIZATION of its cancellation. By becoming a member in the NCE, you acknowledge NCE’s terms and conditions of membership herein. This membership will automatically renew at the end of your membership term on a monthly basis, and your credit card or checking account will be automatically debited for your monthly fees. If you wish to change your payment method, please contact RECRUITING ORGANIZATION at the number indicated above.

TERMINATION: The NCE reserves the right to terminate the Membership of any Member or Member’s dependents or deny eligibility to any person for any reason, including for a Member’s failure or refusal to pay a participating provider of service, or for nonpayment of membership fees payable to RECRUITING ORGANIZATION when due.

CANCELLATION POLICY: Please call the RECRUITING ORGANIZATION to terminate or cancel your membership and to automatically revoke your permission to continue any further payments. This membership can be cancelled for non payment of any amount due.

REFUND POLICY: If you cancel for any reason within the first thirty (30) days of membership, you will receive a full refund of the membership fee. The one-time registration and shipping fees as disclosed are non-refundable.

DESCRIPTION OF BENEFITS: Please refer to your fulfillment materials for a full description of benefits.

ADD OR UPDATE INFORMATION: If you would like to update information for you or your dependants, please call Customer Service at 866-709-8502.

COMPLAINT PROCEDURE: If you would like to file a complaint, please call Customer Service at 866-709-8502.

DISCOUNTS AND SAVINGS ARE NOT INSURANCE BENEFITS.

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Exclusions and Limitations

LIMITATIONS, EXCLUSIONS & EXCEPTIONS

Neither the RECRUITING ORGANIZATION, the Association nor Administrator are licensed insurers, health maintenance organizations, discount medical provider organizations or underwriters of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by the RECRUITING ORGANIZATION or the Administrator.

DISCOUNT MEDICAL BENEFITS ARE NOT INSURANCE: Your membership may contain certain limited supplemental group coverage benefits. Members are responsible for payment in full at the time that medical, legal or other services are provided by benefit providers that are in excess of the Annual Benefit Limit. The RECRUITING ORGANIZATION, the Association, the Administrator, their affiliates, agents, and sales representatives are not responsible for payment of any kind on behalf of members of this association. The benefit providers and Administrators have no liability for providing or guaranteeing service or the quality of service rendered.

DISCOUNTS: This NCE membership makes it possible for members to receive reduced rates on various products and services through participating providers. Discounts received cannot be used in conjunction with any other kind of rate reduction mechanisms. Discounts are based on the provider’s standard fees. Actual discounts will vary depending on the place and the specific services or products purchased. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this Association. In such event, members will be charged the lowest price.

PROVIDERS: It is the member’s responsibility to confirm with Member Services that a provider is an active participant of the program prior to seeing that provider. The Administrator reserves the right to add, change, and/or eliminate any of the service providers included in the Association’s benefits without prior written notice to the member. It is possible that a member may not receive a discount on health related services if they are covered by medical or health insurance or if the services were initiated prior to the member’s activation of this membership.

MEDICAL TREATMENT: The NCE Association, its affiliates, agents, Administrator, and sales representatives are not responsible for providing or failing to provide medical services, treatments, consultations, diagnosis, or advice to a member or to a member’s dependents by any service provider. This program has no liability for providing or guaranteeing medical services or for the quality of services rendered. Selecting a service provider is the member’s obligation, which shall be made at the member’s sole discretion. Such decision shall not be based on the advice, credentials, or recommendation of The NCE, its affiliates, agents, Administrator, or sales representatives. This program does not practice medicine nor does it interfere, participate nor form part of the provider-doctor/member-patient relationship.

SERVICE AVAILABILITY: This program does not guarantee that the products, services or facilities are available in every geographic location within the United States. Not available in all states, call for availability.

Utah Residents: This contract is not protected by the Utah Life and Health Guaranty Association.

Kentucky Residents: This contract is not an insurance policy and is not protected by the Kentucky Life and Health Guaranty Association

New York Residents acknowledge that the savings offered through the network of providers is subject to the network contracts applicable to the laws of New York State.

Washington State Residents: Membership nor any limited supplemental insurance association group policies or their associated benefits are not available to Washington state residents.

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FAQ

FREQUENTLY ASKED QUESTIONS

Do I have to choose a dentist?

No. You may select the dentist of your choice. However, you will receive the highest level of benefits available by choosing an in-network provider. When you visit a participating dentist, you have the opportunity to maximize your benefit plan with access to negotiated network fees, resulting in lower out-of-pocket expenses.

What is a negotiated network fee?

A negotiated network fee refers to a discounted schedule that participating in network providers agree to accept as payment in full for services rendered. Typical discounts range from approximately 20%-35%. Depending on the service rendered, your plan may cover all or part of the discounted fee.

How many dentists are in-network?

There are over 85,000 participating in-network dentists nationwide, including over 15,000 specialists. So, you should be able to locate a participating provider in your area, while traveling, if emergency care is needed, or for your eligible dependents away at college. All in-network dentists meet strict credentialing standards and have agreed to accept negotiated discounts as payment-in-full (no balance billing) for covered services rendered.

How do I locate in-network dentists?

You can conduct online provider searches on our website at www.gacquote.com, or call our member service department at 1-866-910-0849.

Do my dependents have to visit the same dentist that I visit?

No, you and your dependent have the freedom to choose any dentist, and can switch as many times as you would like during the policy year.

Who is covered under the Family Plan?

Enrolled members that meet the definition of Family. “Family” means the Eligible Person, spouse and/or domestic partner and Child(ren). “Child” includes natural child, stepchild, foster child, legally adopted child, a child pending finalization of adoption proceedings, and an individual placed in the custody of an Eligible Person as a result of a guardianship or primary care. ‘Primary care’ means that the Eligible Person provides food, clothing, and shelter, on a regular and continuous basis, for the minor grandchild, niece or nephew during the time that schools are in regular session. “Eligible Child” means any unmarried Child(ren) of the Eligible Person until the end of the calendar month which he/she reaches age 21; or until the end of the calendar month which he/she reaches age 23 if a full-time student (written proof is required).

How do I get reimbursed if I visit an out-of-network dentist?

If you visit a dentist out-of-network, you are responsible for paying the entire amount of the dentist’s usual and customary charge (non-discounted rate) at the time of service. You must then submit a claim form so that we may process your claim, determine the Maximum Allowable Charge and determine if any reimbursement is payable for the claim.

What other benefits are available to me as a NCE member?

There are many valuable benefits as a NCE member that you will receive in your fulfillment packet or can preview on this web site.

How and when do I file a claim?

In-network providers have contractually agreed to file claims for you. If your dentist does not participate in the network (out-of-network), you may have to file the claim yourself. A claim form is included in your welcome kit, it is also available from your benefits administrator, or it can be printed from the website at: www.essentialdentalsolutions.com/claimform . Remember to bring a claim form with you to your appointment so your dentist can help you fill it out. For each claim submission, GDS will expeditiously mail you a concise explanation of benefits and reimbursement according to your plan guidelines.

For questions regarding dental benefits or claims, please call: 1-866-910-0849.

Where should I mail my claim?

GDS – Claims Department
PO Box 10949
Rockville, MD 20849

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Security and Privacy Statement

When you become a GACquote.com customer, you entrust us with your personal data. We consider your data to be private and confidential, and we hold ourselves to the highest standards of trust and fiduciary duty in their safekeeping and use.

General Agent Center (GAC) and our partners will not release information about you or your application, policy or claims information, unless one or more of the following conditions are met:

We receive your prior written consent.
We believe the prospective recipient to be you or your authorized representative.
We are required by law to release information to the recipient.

Questions about your medical history and physical condition are required by our insurance carrier partners and will be released to the insurer so that they may underwrite your insurance application. GAC will not give or sell information about you to any other company, individual, or group without your prior authorization.

GAC will only use information about you to help us better serve your insurance needs or to suggest GAC services or insurance materials that may be of interest to you.

To further protect your privacy, our web site uses the highest levels of Internet security, including data encryption, user names and passwords, and other security tools.

Occasionally, GAC may conduct marketing surveys or research to help us evaluate products, services, and the changing needs of our customers. It is GAC's policy to keep this information confidential.

We will not share individual marketing data gathered from our web site with individuals or business entities not affiliated with GAC.

We know that the privacy of your personal information is important to you. In order to provide you with insurance products of the highest quality and with the service you deserve, it may be necessary for us from time to time to collect nonpublic personal and financial information about you (the "Information") and, in certain situations, to share that Information with others. The following notice describes our policies and practices with regard to your Information.

HOW WE PROTECT YOUR INFORMATION

We maintain physical, electronic and procedural safeguards to protect the Information against unauthorized access and use. We restrict access to the Information to those employees who need access to provide products and services to you and your dependents. The personnel who have access are trained in the proper handling of the Information. Employees who violate this strict level of confidentiality are subject to our disciplinary process.

CATEGORIES OF INFORMATION THAT WE COLLECT

In the normal course of business we may collect the following types of Information:

Information you provide on applications and other forms (including name and address)
Data about your transactions with us (such as types of products you have purchased and your account status)
Information gathered on our Web sites through online forms, site visit data and online information-collecting devices known as "cookies"

HOW WE USE YOUR INFORMATION

We may share your information among the Insurance Companies as permitted by law, including for routine business administration.
We may share information with non-affiliated companies as allowed by law, such as firms that perform services on our behalf, including the administration and marketing of our products. We require these companies to meet strict privacy standards.
We may disclose information to non-affiliated entities when required by law, such as to respond to a subpoena, to prevent fraud or to comply with an inquiry by a government agency.

ACCURACY OF YOUR INFORMATION

We strive to maintain the accuracy of Information that is in our possession about you. In order to help us maintain accuracy, you have the right to reasonably access your information. If you believe any information in our possession is inaccurate, a request can be made to amend or delete the information that you believe to be erroneous. If we concur with the request, we will amend or delete the information in question. You may write our Privacy Office at the address below to receive our complete policy on accessing and amending the Information.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for the Information we already have about you as well as any Information we receive in the future. If we make any material changes to our policies or practices, we will provide you with a copy of a revised Notice. We will post a copy of the current Notice on our websites. The Notice will contain in the top right-hand corner, the effective date.

You may contact our Privacy Office at:

General Agent Center
15575 North 79th Place, Suite 100 Scottsdale, AZ 85260