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Claims | ADA-Sponsored Insurance Plans – Insurance for Dentists and Their Practices

Claims

In the event that you need to file a claim for insurance benefits, we will gladly assist you throughout the entire claims process. Your dedicated Claims Specialist will review your claim and respond to your request as quickly as possible, while offering as much guidance and support as you may need.

 

Debbie Wagner Life & Disability Claims Team Leader

How to file a claim

Simply download and complete the appropriate claim form (or contact us at 866-257-0707), and then send it to us along with the required supporting documentation, as listed on the form. For your protection, we ask that all claims be made in writing. Depending on the type of benefit requested, supporting documentation may include any of the following:

  • Physician's report
  • Death certificate
  • Monthly P&L statements
  • Medical records
  • Federal income tax return

Who should file the claim?

Annually Renewable Term Life, Level Term Life or Term Plus® Universal Life Claims

Claims for an ADA member who is deceased, should be filed by the member's named beneficiary. If you are unsure of who has been named beneficiary, please contact Member Services at 800-568-2001.

Most life insurance claims are processed very quickly, pending receipt of all necessary documentation. We make every attempt to issue benefit checks to beneficiaries within 10 business days after we receive all required information. Please allow a few extra days for your check to reach you via standard U.S. mail.

Annually Renewable Term Life Disability Waiver of Premium and Term Plus Universal Life Disability Waiver of Premium claims should be filed by the ADA Member (primary certificate holder).

Disability Income Protection and Office Overhead Expense Claims

The ADA Member (primary certificate holder) should file any claim under the Disability Income Protection or Office Overhead Expense Plan as soon as possible after the start of your disability. The review process for disability claims can take up to several weeks or longer, depending primarily on the timely receipt of critical information from you and your physicians. Before benefits can be released, reports from your physicians and clinical records, along with any required financial records for you and/or your practice, must be reviewed and you must have satisfied your waiting period.

Your assistance in obtaining clinical information from your physicians and in providing necessary financial documentation can make a big difference in expediting the review process.

MedCASHSM Hospital Claims

The ADA Member (primary certificate holder) should file any MedCASH claim, including those pertaining to a covered spouse or dependent child. Most benefits can be released once you have satisfied the required waiting period (if any). Hospital Coverage benefit checks are typically issued within 10 business days after all necessary claim requirements have been met. Please note that your health insurer's EOB (explanation of benefits) statement does not provide us with all the information we need to process your claim.

MedCASHSM Critical Condition Claims

Critical Condition benefit checks are issued as soon as the appropriate survival period and waiting period have been satisfied, following the receipt of all necessary documentation. Receipt of your medical records is required for Critical Condition benefits; in particular, your physician will need to provide a confirming clinical diagnosis of your qualifying condition before benefits can be paid. In some cases we may need to request additional information.

Payment of benefits for all Plans is subject to approval based on the qualifications outlined in your certificate(s). For additional information about claims procedures or policies, contact us at 866-257-0707 or ada@greatwest.com.

Dentists:This website is not a contract. Benefits are provided under respective Group Policy Nos. (104TLP Annually Renewable Term Life, 1105GDH-IPP Disability Income Protection, 1106GDH-OEP Office Overhead Expense Disability, 104GUL Universal Life, 104LTLP Level Term Life, 1117GH-HIP Hospital Indemnity, 1127GH-CIP Critical Illness, and 1107GH-MCP MedCASHSM) filed in the State of Illinois in accordance with and governed by Illinois law, issued to the American Dental Association, and underwritten by Great-West Financial®. All ADA-sponsored coverage is subject to underwriting and is not guaranteed issue unless specifically stated otherwise. Coverage that is guaranteed issue is subject to a pre-existing condition limitation. The ADA is entitled to receive royalties from the ADA Members Insurance Plans. Coverage is available to all eligible ADA members and student members in all fifty states and U.S. territories under the aforementioned group policy. Level Term Life premiums are fixed based on the selected duration of 10 or 20 years. Must maintain membership throughout selected term. Annually Renewable Term Life, Hospital Indemnity, Critical Illness, and MedCASH premiums increase annually based on age. Recommended premiums under the Term Plus® Universal Life plan consist of the cost of insurance (which may vary based on the member’s age and coverage amount), the amount chosen by the member for deposit into his/her Policy Value Account and a service charge. Premium deposits may fluctuate or remain level depending upon the amount maintained in the Policy Value Account. Disability Income Protection premiums increase every 5 years and Office Overhead Expense every 10 years based on age. Premium credit for Annually Renewable Term Life and Term Plus Universal Life is not guaranteed but reevaluated annually. Premium credit for Disability Income Protection, Office Overhead Expense, Hospital Indemnity, Critical Illness, and MedCASH is not guaranteed but reevaluated semi-annually. Each Plan participant will receive a Certificate of Insurance explaining the terms and conditions of the policy.


Dental Students: This website is not a contract. Student coverage is issued regardless of your condition if you are under 45. If you are 45 or older, you can apply for the no-cost coverage and all student program features by providing proof of good health. Coverage renews automatically each academic year. Individuals may convert coverage to the plans for practicing dentists after graduation by paying ADA member premiums and maintaining ADA membership. Benefits are provided through a group policy Nos. (104TLP Term Life and 1108GDH-SDP Student Disability) filed in the State of Illinois in accordance with and governed by Illinois law, issued to the American Dental Association, and underwritten by Great-West Financial®. All ADA-sponsored coverage is subject to underwriting and is not guaranteed issue unless specifically stated otherwise. Coverage that is guaranteed issue is subject to a pre-existing condition limitation. Coverage is available to eligible ADA members and student members in all fifty states and US territories under the aforementioned group policy. Each insured will receive a certificate of insurance explaining the terms and conditions of the policy.


ADA® is a registered trademark of the American Dental Association and Great-West Financial® is a registered trademark of GWL&A.


Great-West Financial® refers to products and services provided by Great-West Life & Annuity Insurance Company, Greenwood Village, CO, its subsidiaries and affiliates. GWL&A is not licensed in New York, but eligible members residing in New York may request and ultimately receive coverage under the aforementioned group policy. The trademarks, logos, service marks, and design elements used are owned by Great-West Life & Annuity Insurance Company. ©2017 Great-West Life & Annuity Insurance Company. All Rights Reserved. For website issues, contact the Webmaster at ADA_WebMaster@greatwest.com.

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