TruAssure's Basic, Preferred and Preventive dental plans are offered in association with the DenteMax Plus dental network. Both in-network and out-of-network services are paid off of the PPO fee schedule.
TruAssure's network dentists accept pre-negotiated fees at a reduced rate as payment in full. Deductible and co-payment may apply. If you visit an in-network dentist, you cannot be balance billed. Balance billing is when a dentist bills you for the difference between TruAssure's allowed fee and his or her usual fee. If you visit an out-of-network dentist, they can "balance bill" you.
If you visit a dentist that is not a part of the DenteMax Plus dental network, you may be liable for all charges for dental services received, except for emergency dental care.
To find an in-network dentist near you, visit our Find a Dentist page.
After a covered individual receives covered dental services, the individual should file a claim only if their dentist has not filed one for them.
If the covered individual must file a claim with us, the claim should not be submitted to us until the covered dental service is completely finished. A claim should not be filed for payment before the covered dental service is completed.
If you visit an in-network dentist, they will submit the claims for you. If you visit an out-of-network dentist, you may need to submit a claim form yourself. If you need to submit a claim, download a claim form, complete, and mail to the address below:
TruAssure Insurance Company
P.O. Box 4495
Lisle, IL 60532
PAYOR ID: ILDTA
Claims must be submitted within ninety (90) days (North Carolina within 180 days, Texas within 91 days) after dental treatment. For more information or assistance with submitting a dental claim, please call our customer service department at 888-559-0779 between Monday - Thursday, 7:00 a.m. to 5:30 p.m. (CST) and Friday, 7:00 a.m. to 5:00 p.m. (CST) or email CSI@TruAssure.com or fill out our Customer Service Contact Form.
Please note: If you visit a dentist that is not a part of the DenteMax Plus dental network, you may be liable for all charges for dental services received, except for emergency dental care.
Coverage will be provided for emergency dental care from any dentist. Benefits for emergency dental care will be paid at in-network benefits. However, if you go to an out-of-network dentist, you will be responsible for the difference between the submitted amount we receive from your dentist and our payment.
Written proof of loss must be given to us at our home address shown on the cover page of your policy within ninety (90) days from the date of loss. Failure to furnish such proof within the time required will not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible, and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.
Written proof of loss must be given to us at our home address shown on the cover page of your policy within 180 days from the date of loss. Failure to furnish such proof within the time required will not invalidate nor reduce any claim if it was not reasonably possible, and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.
Written proof of loss must be given to us at our home address shown on the cover page of your policy before the 91st day after the date of loss. Failure to provide the proof within the required time does not invalidate or reduce any claim if it was not reasonably possible to give proof within the required time. In that case, the proof must be provided as soon as reasonably possible but not later than one year after the time proof is otherwise required, except in the event of legal incapacity.
Premiums are to be paid by you to us on each premium due date. While each premium is due by the due date, there is a grace period for each premium payment.
After the first due premium payment, if a premium is not paid on or before the date is due, it may be paid during the next thirty-one (31) days. These thirty-one (31) days are called the grace period. Coverage under your policy will remain in force during the grace period. Your policy will automatically terminate after the end of the grace period if any premium is unpaid.
If no APTC is applied to your policy, the following grace period provision does not apply to you.
Premiums are to be paid by you to us on each premium due date. While each premium is due by the due date, there is a grace period for each premium payment.
You must pay all premiums due before coverage can begin and before this grace period applies to you.
If you have paid your first month's premium in full, subsequent monthly premium payments are to be paid on or before the date it is due. Your policy permits three (3) months for you to pay all outstanding premiums due. These three months are called the grace period. Coverage under your policy will remain in force during the grace period.
During the first month of the grace period, we will continue to pay claims incurred for covered dental services. During the second and third months of the grace period, we will suspend payment of any claims until we receive the past-due premiums. If payment is not received for all outstanding premiums by the end of the grace period, your policy will be terminated effective at 11:59 p.m. on the last day of the first month of the grace period. You will be responsible for expenses incurred of any covered dental services you or your covered dependents received after the last day of the first month of the grace period.
Claims that have been submitted but not yet paid because additional information is needed.
When the dentist is paid directly: Unless the covered individual's payment responsibility is zero, the covered individual will receive an Explanation of Benefits (EOB) that describes the services his or her dentist submitted and the benefits that the policy covers. The treating dentist will receive an Explanation of Payment along with the payment.
When You are paid directly: Along with your payment, we will provide you with an Explanation of Payment that describes:
When the dentist is paid directly: The covered individual will receive an Explanation of Benefits (EOB) that describes the services his or her dentist submitted and the benefits that the policy covers. The treating dentist will receive an Explanation of Payment along with the payment.
When you are paid directly: Along with your payment, we will provide you with an Explanation of Payment that describes:
You can access your claims at any time through our Member Portal. To register for our Member Portal, follow these easy steps. You can also contact us for further assistance.
A retroactive denial is the reversal of a previously paid claim, through which the enrollee then becomes responsible for payment.
TruAssure does not retroactively deny claims.
Enrollee recoupment of overpayments is the refund of a premium overpayment by the enrollee due to the over-billing by the issuer.
TruAssure does not refund overpayment of premium by the enrollee. If overpayment is received, TruAssure provides credit to the enrollee's account.
A pre-treatment estimate for dental procedures is not required. However, a pre-treatment estimate is recommended for treatment plans exceeding $300. The pre-treatment estimate lets you know in advance whether the requested services are covered under your policy.
A pre-treatment estimate for dental procedures is not required. However, a pre-treatment estimate is recommended for treatment plans exceeding $300. The pre-treatment estimate lets you know in advance whether the requested services are covered under your policy.
There are no ramifications for not obtaining a pre-treatment estimate.
An Explanation of Benefits (EOB) is a document that you receive from your dental insurance carrier after your dental claim is paid. The EOB shows the fee submitted by your dentist, what TruAssure paid, and any amount you may owe (such as the deductible, co-payments, or non-covered services). The EOB is not a bill, but rather an overview of the dental services you received and what was covered by your dental plan.
You can access your EOB at any time through our Member Portal. To register for our Member Portal, follow these easy steps.
When the dentist is paid directly: Unless the covered individual's payment responsibility is zero, the covered individual will receive an Explanation of Benefits (EOB) that describes the services his or her dentist submitted and the benefits that the policy covers.
When the dentist is paid directly: The covered individual will receive an Explanation of Benefits (EOB) that describes the services his or her dentist submitted and the benefits that the policy covers. The treating dentist will receive an Explanation of Payment along with the payment.
Coordination of Benefits (COB) occurs when you and/or your dependents are enrolled in more than one dental plan. Except in Kansas, TruAssure may coordinate the two dental plans so that the total payment does not exceed 100 percent of the total covered expenses for dental services received.
Coordination of Benefits varies by state and is reviewed by TruAssure on a claim by claim basis.