SERVICE CENTER
Employee > FAQs
Frequently Asked Questions
What is a group open enrollment period?
Group open enrollment is an annual period of at least 30 days during which eligible employees and/or dependents may enroll in the health plan if they are not currently enrolled.
Can I choose my own dentist?
Yes, Kansas City Life allows dental plan members to choose from any practicing dentist.
Additionally, all dental plan participants have access to the Connection Dental Network. There are more than 58,000 participating providers in the network who have agreed to reduce their charges. This reduction means your dental dollars will work harder for you.
You can search for dentists in your area by logging on to www.ppousa.com or calling PPO USA toll free at 877-277-6872 between 8 a.m. and 5 p.m. Monday through Friday.
What if I need a second opinion?
You may request a second medical opinion if you disagree with your dentist or the dental plan’s determination regarding the reasonableness or necessity of a surgical procedure. You may also request a second opinion if you feel you’re not responding satisfactorily to your current treatment plan after a reasonable lapse of time.
Will my information remain confidential?
All patient information is considered confidential, is governed by confidentiality policies and procedures, and will not be disclosed unless required by law. We may use confidential health information to process claims, perform quality audits, improve services and respond to appeals. In cases where we need additional information that is confidential, we will not release that information without your express written consent. Please click here to read our privacy policy.
Financially, what are my responsibilities?
When you receive care from any dental provider, you are responsible for any applicable co-payment, deductible, and coinsurance, as well as payments for services not covered by your dental plan, as explained in your policy. Your providers may request payment of co-payment at the time of service.
What does "in-network" mean?
An "in-network" provider is a dental provider that has agreed to supply covered services to members as a cost savings enrolled in the network. A listing of Connection Dental Network providers is available on the web at www.ppousa.com or by calling PPO USA toll free at 877-277-6872 between 8 a.m. and 5 p.m. Monday through Friday.
What does "out-of-network" mean?
An out-of-network provider is a dentist that has not contracted with the Connection Dental Network (PPO USA).
What is a co-pay?
A co-pay, or co-payment, is the amount you are responsible to pay the provider directly at the time of an office visit or other treatment. Your co-payment amount for various services is listed in your Schedule of Benefits.
What is a deductible?
A deductible is the pre-determined amount you are responsible to pay out-of-pocket for covered services during the policy year before the dental plan starts paying. Only covered services apply toward the deductible.
What is coinsurance?
Coinsurance is the percentage of charges you are responsible for after you have met your deductible for the policy year. Your percentage amount can be found in your Schedule of Benefits.
What are Usual, Customary and Reasonable (UCR) fees?
The Usual fee is the fee usually charged for a given service by an individual provider to his or her private patient. The Customary fee is the range of usual fees charged by providers of similar training and experience in an area. The Reasonable fee is a fee that meets the two previous criteria or, in the opinion of the responsible medical or dental association’s review committee, is justifiable considering the special circumstances of the particular case in question.
How do I know what my deductible and coinsurance are?
Both are outlined in your Schedule of Benefits. You can also consult your employer’s benefits coordinator or contact us for information on deductibles and coinsurance.
Student Coverage
Will my child have coverage while away at college?
Your child must meet the criteria of a covered dependent in the Schedule of Benefits. Proof of student status will be required for claims filed on dependents that are college age.
Until what age is my child covered?
Students are eligible until they have reached the student-eligibility age (according to your Schedule of Benefits) or when they are no longer a full-time student, whichever comes first. Check with your employer for details.
What is required to show proof of student status?
We may request current full-time student status information twice a year (spring and fall semester). Acceptable documents include:
- A copy of a class schedule
- A receipt for payment of full-time tuition
- A letter from the institution.
Coordination of Benefits
What if I (or my dependents) also have coverage through another carrier?
If you have additional coverage, it is your responsibility to provide us with this information as soon as possible so that we can coordinate benefits with the other policy. You may receive a request annually asking you to update this information.
Grievances & Appeals
What can I do if I have a grievance or do not agree with a decision on a denied claim?
We would recommend you contact Customer Service if you disagree with a payment decision made on a claim. If your question is not resolved to your satisfaction you may also request an appeal in writing. Mail your appeal to:
Kansas City Life
Attention: Appeals Coordinator
PO Box 219325, Kansas City, MO 64121-9325.
Eligibility
How do I change my address?
Employees should contact their employer about any changes to their eligibility record.
How do I add or terminate a dependent?
Employees should contact their employer about any changes to their eligibility record.
How can I obtain a new or additional ID card?
Employees should request a new or additional ID card through their employer.