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ACA Plans

Information for individuals who are enrolled in an ACA (Affordable Care Act) certified dental plan through the Health Insurance Marketplace:


Out-of-network Liability and Balance Billing

TruAssure dental plans are offered in association with DenteMax dental networks. DenteMax dentists accept new patients. Both in-network and out-of-network services are paid off 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.

To find an in-network dentist near you, visit our Find a Provider page

Enrollee claims submission

After a covered individual receives covered dental services, he or she should file a claim only if his or her dentist has not filed one for him or her.

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:

TruAssure Insurance Company
P.O. Box 4495
Lisle, IL 60532
PAYOR ID: ILDTA

Claims must be submitted within 90 days (North Carolina 180 days, Texas 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, 8:30 a.m. to 5:00 p.m. central time, Monday through Friday, or by email at CSI@TruAssure.com.

Proof of Loss

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.

For North Carolina Residents:

Proof of Loss

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.

For Texas Residents:

Proof of Loss

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 reasonable possible to give proof within 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 a legal incapacity.

Grace periods and claims pending policies during the grace period

This Grace Period provision applies if you are not receiving advance payment of premium tax credit

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 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.

This Grace Period applies if you are receiving advance payment of premium tax credit

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 premium 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.

How will you know when claims are processed?

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:

  1. The services the treating dentist submitted for you or your covered dependent; and
  2. The covered dental services insured under the policy.

For Nebraska residents:

How will you know when claims are processed?

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:

  1. The services the treating dentist submitted for you or your covered dependent: and
  2. The covered dental services insured under the policy.

You can access your claims any time through our Member Portal. To register for our Member Portal, follow these easy steps. You can also Contact Us for further assistance.

Retroactive denials

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

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 on the enrollee's account.

Pre-Treatment Estimate timeframes and enrollee responsibilities

A predetermination of benefits, or pre-treatment estimate, for dental procedures is not required. However, a predetermination 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.

For Michigan, Mississippi and Wisconsin residents:

A predetermination of benefits, or pre-treatment estimate, for dental procedures is not required. However, a predetermination is recommended for treatment plans exceeding $200. 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.

Information on Explanations of Benefits (EOBs)

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 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.

For Nebraska residents:

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

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.

TruAssure Insurance Company complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, gender, or gender identity.