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1 The additional maximum dollars cannot be used for orthodontia services.
This dental plan does not provide coverage for pediatric oral health services that satisfies the requirements for “minimum essential coverage” as defined by the Patient Protection and Affordable Care Act. (“PPACA”).
Group insurance policies are underwritten by Sun Life Assurance Company of Canada (SLOC) (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 15-GP-01 and 16-DEN-C-01. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (SLHIC) (Lansing, MI) under Policy Form Series 15-GP-01 and 16-DEN-C-01. Administrative Services Only services for self-funded dental plans are administered by SLOC in all states except New York. In New York, they are administered by SLHIC. Product offerings may not be available in all states and may vary depending on state laws and regulations. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For cost and complete details of the coverage, please contact the company.
Sun Life Assurance Company of Canada (Wellesley Hills, Mass.) issues group policies in all states, except New York. In New York, Sun Life and Health Insurance Company (U.S.) (Lansing, Mich.) issues group insurance policies.
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