SERVICE CENTER
Employer 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 58,0000 participating providers in the network who have agreed to reduce their charges. This reduction means employees’ dental dollars will work harder.
You and your employees 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?
Employees may request a second medical opinion if they disagree with their dentist or the dental plan’s determination regarding the reasonableness or necessity of a surgical procedure. They may also request a second opinion if they feel they’re not responding satisfactorily to the current treatment plan after a reasonable lapse of time.
Will 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 employees’ express written consent. Please read our privacy policy.
Financially, what are the responsibilities?
When employees receive care from any dental provider, they are responsible for any applicable co-payment, deductible, and coinsurance, as well as payments for services not covered by their dental plan, as explained in their policy. Healthcare 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. 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 employees are responsible to pay the provider directly at the time of an office visit or other treatment. Their co-payment amount for various services is listed in the Schedule of Benefits.
What is a deductible?
A deductible is the pre-determined amount employees 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 employees are responsible for after they have met their deductible for the policy year. The percentage amount can be found in the 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 the deductible and coinsurance are?
Both are outlined in the Schedule of Benefits. Employees can also consult their employer’s benefits coordinator or contact us for information on deductibles and coinsurance.
Student Coverage
Will a child have coverage while away at college?
Children 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 a child covered?
Students are eligible until they have reached the student-eligibility age (according to the Schedule of Benefits) or when they are no longer a full-time student, whichever comes first.
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 employees (or their dependents) also have coverage through another carrier?
If employees have additional coverage, it is their responsibility to provide us with this information as soon as possible so that we can coordinate benefits with the other policy. They may receive a request annually asking them to update this information.
Grievances & Appeals
What can employees do if they have a grievance or do not agree with a decision on a denied claim?
We recommend they contact Customer Service if they disagree with a payment decision made on a claim. If the question is not resolved to their satisfaction they may also provide an appeal in writing. The appeal can be mailed to:
Kansas City Life
Attention: Appeals Coordinator
PO Box 219325
Kansas City, MO 64121-9325.
Eligibility
How do employees change their address?
When an employee’s address changes or is incorrect a “Change of Information Request” card (Form G129) should be completed, signed and sent to Kansas City Life Insurance Company with the next premium payment. This will eliminate delays in receiving pre-authorization information or Explanations of Benefits (EOB). Employees should contact their employer about any changes to their eligibility record.
How do employees add or terminate a dependent?
When an employee wants to cancel a dependent’s insurance, a “Change of Information Request” card (Form G129) must be completed, signed and submitted within 31 days of the date change occurred. All adjustments will be made on the next premium statement. Employees should contact their employer about any changes to their eligibility record.
How can employees obtain a new or additional ID card?
A supply of identification cards will be mailed to the group administrator at inception of the group plan. These should be distributed to existing employees with an additional supply for new employees. Employees enrolled for single coverage should receive one identification card. Employees enrolled for family coverage should receive two identification cards.
Employees and their eligible dependents may use the card when dental care is required. (The identification card is not a guarantee that benefits are payable, but is to be used for information purposes only.) Encourage employees to carry the card with them at all times.
When your supply runs low, contact your Group Contract and Customer Service Representative. Please allow three weeks for these to be produced and delivered.
Employees should request a new or additional ID card through their employer.