What is the difference between disability income and office overhead expense insurance?

While both disability income and office overhead expense insurance cover the risk of becoming disabled due to an accident or illness, such as the COVID-19 coronavirus, the benefits they provide are very different.

Office Overhead Expense insurance helps reimburse the monthly cost of eligible business expenses to maintain a dental practice during the practice owner's absence due to a disabling accident or illness. Disability Income insurance is designed to help replace the insured's personal income in the event they are unable to actively practice due to a disabling accident or illness. ("Actively" practicing under the ADA Plans is defined as a minimum of 20 hours per week.)

How do I file a claim if I become disabled and unable to practice due to COVID-19 coronavirus?

Simply download and complete the applicable claim packet and return to us along with the required supporting documentation. Supporting documentation for disability income and office overhead claims include the following:

• Report from your attending physician with medical records attached;
• Monthly P&L statements;
• Monthly production reports (24-month period prior to disability) with CDT codes; and
• Federal income tax returns.

What benefits are available under the ADA Disability Income Protection Plan?

The Disability Insurance Plan offers up to $15,000/month of coverage to help replace the dentist member's personal income from dental practice in the event of an accident or illness, such as the COVID-19 coronavirus, which prevents him or her from performing the normal duties of their "own" occupation (dentistry). ADA's Plan has a true own occupation definition which means it provides full monthly benefits, payable up to age 67, in the event the insured is totally disabled from practicing dentistry or their special area of practice, regardless of whether they are able to work in another area of dentistry or choose to enter a new occupation. As with most disability plans, the insured must be under the care of a physician who can verify total disability to file a claim.

What benefits are available under the ADA Office Overhead Expense Plan?

The ADA Office Overhead Expense Plan offers up to $25,000 per month for reimbursement of eligible overhead costs, including staff salaries and benefits, mortgage/lease payments, utilities, loans, etc., in the event of the insured's total (or partial) disability, after satisfying a 30-day waiting period. Benefits are payable retroactively to the first day of disability for up to 12 to 24 months depending on the coverage option purchased. In addition, in the event the dentist practice owner needs to hire a locum tenens (replacement dentist) to maintain the practice during his or her period of disability, the Plan provides up to six months additional coverage over and above the monthly benefit to cover this extra expense. If a dentist were to contract the COVID-19 coronavirus and medically qualify for disability, he or she should look to their disability related insurance policies to cover any potential financial loss of income.

Are hospitalizations or visits to a hospital emergency room related to the COVID-19 coronavirus covered under the ADA MedCASH and Hospital Indemnity insurance plans?

Yes. Both the ADA MedCASH and Hospital Indemnity insurance plans pay for emergency room visits up to 5 times per year; the MedCASH plan pays 50% of the insured’s daily rate and the Hospital Indemnity plan pays 100%. Hospital admissions are covered at 100% of an insured’s daily rate under both plans. More important, ICU confinements are covered at 200% when the insured’s confinement begins prior to age 65 under the MedCASH plan and prior to age 70 under Hospital Indemnity. If you’ve elected to cover your spouse and/or dependent children, they too would be eligible for this same coverage.

Will my coverage remain in effect if I’m ill and inadvertently miss a premium payment?

Each of the eight group policies offered under the ADA Members Insurance Plans contain a 31-day grace period during which coverage continues without interruption following the premium due date. If the premium due is not received within the 31-day grace period, coverage will lapse for non-payment. Should that happen, you can expect to receive a lapse notice and reinstatement offer which allows the insured member to reinstate coverage for a limited period of time without proof of good health if the premium payment is received no later than 31 days following the end of the grace period.

ADA insured members can register their insurance accounts online in order to enjoy the convenience and peace of mind of 24/7 access. Once registered, the insured member will be able to confirm whether a premium is due and make an online payment using a credit card or bank account. Registering also allows the insured member to view when premium payments are received. More important, the insured member can enroll in Autopay which is a convenient way to ensure coverage continues without interruption during planned time away for vacations and business travel or in the event of a sudden accident or illness such as contracting the COVID-19 coronavirus.

Who do I call to learn more about my coverage under the ADA Members Insurance Plans issued by Great-West Life & Annuity Insurance Company?

ADA Members Insurance Plans Service Center:

For questions about your ADA Members Insurance Plans coverage, premiums and billing, beneficiary assignment, or to simply enroll in Autopay or to change a mailing address, certificate holders can reach the ADA Service Center weekdays from 8:30 am to 5:00 pm Central Time at 800-568-2001. ADA insured members can also email questions to:

• Email – ada@protective.com

For questions about filing a claim or the status of a claim already submitted, ADA insured members can reach a claims consultant by phone or email to:

• Phone - 866-257-0707 (weekdays from 9:00 am to 5:00 pm Central Time)
• Email – ada@protective.com

Will the COVID-19 pandemic affect my paramedical exam for medical underwriting?

ExamOne, the company we utilize for paramedical exams, is currently postponing in-person exams in some counties due to the ongoing health crisis. Outside of those counties, the paramedical service providers are following orders directed by the state. Unfortunately, your personal physician cannot complete the exam because they do not run the same blood test results that we require for insurance purposes. Please call one of our associate underwriters at 866-221-3348 or email adacasemanager@protective.com if you have further questions.

Will my coverage under the Disability Income Protection and/or Office Overhead Expense Plans remain in effect while I’m unable to work at least 20 hours per week because of government-mandated closures due to COVID-19?

Yes, coverage will remain in effect for at least 60 days. You are considered to be Actively Working Full-Time under both the Disability Income Protection and Office Overhead Expense Plans during scheduled absences that do not exceed 60 consecutive days. We are applying this provision to COVID-19 stay-at-home orders. If stay-at-home orders last longer than 60 days, we will assess the situation at that time and consider extending this time frame.