Any person who knowingly presents a false or fraudulent
claim for payment of a loss or benefit or knowingly presents false
information in an application for insurance is guilty of a crime and may be
subject to fines and confinement in prison.
STATE SPECIFIC NOTICES:
(California) For your protection California law
requires the following to appear on this form. Any person who knowingly
presents a false or fraudulent claim for the payment of a loss is guilty of
a crime and may be subject to fines and confinement in state prison.
(Florida) Any person who knowingly and with intent to injure,
defraud, or deceive any insurance company files a statement of claim or an
application containing any false, incomplete, or misleading information is
guilty of a felony of the third degree.
(Kentucky) Any person who knowingly and with intent to defraud any
insurance company or other person files an application for insurance
containing any materially false information or conceals, for the purpose of
misleading, information concerning any fact material thereto commits a
fraudulent insurance act, which is a crime.
(Louisiana) It is a crime to knowingly provide false, incomplete or
misleading information to an insurance company for the purpose of defrauding
the company. Penalties may include imprisonment, fines or a denial of
insurance benefits.
(Maryland) Any person who knowingly and willfully presents a false or
fraudulent claim for payment of a loss or benefit or who knowingly and
willfully presents false information in an application for insurance is
guilty of a crime and may be subject to fines and confinement in prison.
(Missouri) An insurance company or its agent or representative may
not ask an applicant or policyholder to divulge in a written application or
otherwise whether an insurer has canceled or refused to renew or issue to
the applicant or policyholder a policy of insurance. If a question appears
in this application, you should not renew it.
(Pennsylvania) Any person who knowingly and with intent to defraud
any insurance company or other person files an application for insurance or
statement of claim containing any materially false information or conceals
for the purpose of misleading, information concerning any fact material
thereto commits a fraudulent insurance act, which is a crime and subjects
such person to criminal and civil penalties.
(Washington) Any person who knowingly presents a false or fraudulent
claim for payment of a loss or knowingly makes a false statement in an
application for insurance may be guilty of a criminal offense under state
law." (All Other States) Any person who knowingly and with intent to defraud
any insurance company or other person, files an application for insurance or
statement of claim containing any materially false information or conceals
for the purpose of misleading, information concerning any fact material
thereto commits a fraudulent insurance act, which is a crime and subjects
such person to criminal and/or civil penalties.
(New York) Any person who knowingly and with intent to defraud any
insurance company or other person files an application for insurance or
statement of claim containing any materially false information, or conceals
for the purpose of misleading, information concerning any fact material
thereto, commits a fraudulent insurance act, which is a crime and shall also
be subject to a civil penalty not to exceed five thousand dollars and the
stated value of the claim for each such violation.
IMPORTANT INFORMATION - upon receipt of your
completed application you will receive a copy of your Certificate of
Insurance and Identification Card. Do not cancel any other dental coverage
you may have until you receive written confirmation from the insurance
company you have selected.
We use this dental plan rating software
