General
Is this a discount plan or insurance?
This is a Limited Benefit Insurance policy. That means it is a medical plan with restricted benefits, but lower premiums.
How does the plan work?
After the yearly deductible has been satisfied, then the following percentages will reimburse expenses up to yearly max.*
- 60% - first policy year
- 70% - second policy year
- 80% - third policy year and thereafter.
*You can visit any provider of your choice. Additional savings available through an approved MOA provider for vision care and Preferred Plus or Careington Networks for dental care.
What is the annual max?
It is the maximum amount of money the policy will pay out during your policy’s year, from your personal start date to the next. You may select either $1000 or $1500.
How do I file a claim?
As a policyholder, you have a couple of options. Approved MOA DVH vision providers and Preferred Network, Preferred Plus Network and Careington Network dental providers will all file the claim on your behalf. If your provider is not in the network, you can still ask them to file the claim for you. Many providers will help you.
If you need to file a claim for yourself, you may go to the policyholder login on the www.Manhattanlife.com website and print out your claim form there or you can print the forms directly from the top menu on this website, www.moadvh.com. After you fill out the claim, you may scan and submit it with the Easy Upload option (in PDF only). You may also:
- Fax to 713-583-0677
- Mail to:
Claims Department
P.O. Box 925309
Houston, TX 77292-5309
*If you choose to mail the claim, please note this can cause a slight delay in processing and is not the preferred method of claims submissions.
If you need help, call the Customer Service Department at 800-669-9030 or call your agent. They can also print the form, help you fill it out, and submit it from their online portal.
Is there an age limit?
In most states, enrollment ends at the age of 85. There is no termination by age, so you may keep your policy as long as you pay your premiums.
Is there a deductible?
Yes, there is a small $100 annual deductible. It is an overall deductible, not separate for dental or vision care.
Can I have health coverage with a different company than my dental coverage?
Yes. This plan is a versatile product that can be used with or without another plan from any company.
How do I know if I’m eligible for this plan?
This plan is guaranteed issue. However, you must meet the age requirement.
Can I become ineligible?
No. This plan guarantees renewability for the life of the policy, so long as the premiums are paid on time.
Does this plan cover any pre-existing conditions?
Yes, but all pre-existing conditions, whether disclosed in the application or not, are subject to a twelve-month waiting period.
How does this work with my Medicare?
It has no effect with your Medicare since it does not coordinate benefits.
How often will my premium change?
Premiums are subject to change at any time.
How does the policy work?
The policy is a simple and easy to understand plan design. There is a “pool” of funds (either $1,500 or $1,000 per covered person per year) and this “pool” is available for the insured to use for any of the covered dental, vision or hearing expenses.
Why are the premiums so low?
This policy is a proprietary policy of the Missouri Optometric Association which is a Missouri based nonprofit professional association. Their working partner, the Missouri Dental Association is the same. The policy was designed to accomplish a common goal, provide exceptional services to our patients at an affordable cost.
How is the family plan premium determined?
To determine premiums, ManhattanLife uses "age of last birthday". The family premium is based on the older age of the two adults for a two-parent family and the age of the adult for a single-parent family. If applying within a group policy for a family plan, then the premium is based on the age of the last birthday of the employee.
The family plan provides an averaged premium rate for up to 3 children. Each additional child (age 3-17) can be added to the family policy for the "additional child premium". For example, add the additional child premium rate to the appropriate family rate premium to determine the premium for a family with 4 children.
Vision
Can I use the Vision component for my cataracts or Lasik surgery?
Unfortunately, no. This is a limited benefits plan. To keep premiums low some services will not be covered.
When can I start using vision insurance?
Immediate coverage for exam, glasses and contact lenses.
How does the policy work?
The policy is a simple and easy to understand plan design. There is a “pool” of funds (either $1,500 or $1,000 per covered person per year) and this “pool” is available for the insured to use for any of the covered dental, vision or hearing expenses.
What is the value of the MOA Provider Network?
By seeing an approved MOA DVH provider for vision, you will see significant, additional savings. After you meet your $100 deductible (and as long as you have sufficient benefits available for your policy year), then the office will accept as full payment from ManhattanLife with no additional cost to you for:
- Eye Exam
- Refraction
- Prescribed vision lenses, either single, bifocal, trifocal, or progressive
- Anti-reflective or Non-Glare
- Polycarbonate lenses (thinner, lighter, impact-resistance)
- Frames (up to $250 retail value)
- Your provider can help you and give you additional information on cost savings for more expensive frames.
Items that do not fall into these categories (i.e. specialty lenses) such as transition lenses or extra thin lenses will be the patient’s responsibility at the regular office price.
Hearing
Can I get a hearing aid?
Yes, after the 12 month waiting period for new, or repairs to, hearing aids.
How does the policy work?
The policy is a simple and easy to understand plan design. There is a “pool” of funds (either $1,500 or $1,000 per covered person per year) and this “pool” is available for the insured to use for any of the covered dental, vision or hearing expenses.
Dental
I usually see dental by itself. Why should I get a plan with dental, vision, and hearing lumped together?
This plan was designed to meet as many needs as possible. Since it does not coordinate benefits, you may have an additional dental or vision plan. You may use parts of all of the coverage each year, or use all of your benefits towards one area. This plan offers versatility that you cannot get with dental alone.
When can I start using this?
Immediately. However, some services do have a waiting period.
We will not pay benefits for the following in the first year: endodontics (including root canals), periodontal surgery, bridges, crowns, full dentures or partials, any work relating to the replacement of natural teeth which were missing at the time coverage becomes effective, “full mouth” extractions, fluoride treatments, and outpatient dental surgery.
Can I use this with another dental plan?
Yes. This plan does not coordinate benefits.
Must I have health insurance to have a dental plan?
No.
Can I keep my preferred dentist?
Yes. This is a reimbursement plan.
Does this cover braces or orthodontics?
Unfortunately, no. This is a limited benefits plan, so to keep premiums low some services will not be covered.
Is tooth whitening covered?
No, this is often considered a cosmetic procedure and is not covered by this policy. If a dentist were to rule it medically necessary and you receive pre-approval, then it could be covered. Check with your provider for additional details.
Can I get my wisdom teeth extracted?
Yes, unless you receive the diagnosis that they are impacted.
How does the policy work?
The policy is a simple and easy to understand plan design. There is a “pool” of funds (either $1,500 or $1,000 per covered person per year) and this “pool” is available for the insured to use for any of the covered dental, vision or hearing expenses.
Why is there no orthodontic coverage?
The traditional dental plan that includes orthodontics as a coverage rider builds this cost into the premium for every covered individual. Normal usage of these services is approximately 3%. By removing this coverage, the other 97% save premium dollars and the few that need orthodontics can better afford it by utilizing a portion of their annual premium savings.
What is the value of the Preferred Plus and Careington Networks?
Policyholders can use any provider for dental care. However, additional savings may be available by selecting a provider within the Preferred Plus or Careington Networks. Using the network providers helps the policy year benefit to last longer.
Additionally, the Dental Preferred, Preferred Plus and Careington Network providers will file the claim for you after your visit.