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Dental Insurance

Frequently Asked Questions About Dental Insurance

What types of dental plans are available?
When can I start making appointments with my dentist?
Does my dental plan cover orthodontia?
Does my dental plan cover dentures?
My spouse is losing his/her job and won t have insurance. When can I add him/her to my dental insurance?
What happens to my dental insurance in the event of a layoff, illness, or other types of leave?
What happens to my dental insurance during a period of personal leave without pay?
What happens to my dental insurance when I retire?
What happens to my dental insurance when I resign or my appointment ends?

Dependent Coverage
We will be having/adopting a child soon. How do I add this child to my health, dental, and life insurance coverage?
When can my dependents be added to my health, dental, and vision plans?
How long can my child be insured as my dependent?


What types of dental plans are available?
There is one type of dental plan available. The Quality Care Dental Plan permits you to see any dentist you choose. Under the Quality Care Dental Plan, a specific dollar amount, or scheduled benefit, is payable for each covered service. For example, the current benefit for an adult teeth cleaning is $78. That means the plan will pay $78 toward the dentist's charge; any remaining charge is the employee's responsibility. The specific benefit payable for each covered service is listed in the Dental Schedule of Benefits located on the CMS website. Either the dentist or the employee must file claims in order to collect benefits. Claim forms are available online.

When can I start making appointments with my dentist?
You may begin making appointments with your dentist on your first day of employment. Your coverage becomes effective that day; however, you will not receive your insurance cards for approximately two weeks after you have submitted your enrollment paperwork. If you see your dentist before you receive your card, you will need to make the office aware of your insurance plan carrier.

Does my dental plan cover orthodontia?
A $2,000 lifetime maximum benefit for child orthodontics is included in this plan. Effective July 1, 2013 the lifetime maximum for out-of-network child orthodontia is $1,500. This lifetime maximum applies to each plan participant regardless of the number of courses of treatment. Certain limitations and exclusions apply to orthodontia coverage as listed in the Dental Schedule of Benefits located on the CMS website. You should review this information before beginning any course of treatment.

Does my dental plan cover dentures?
Coverage for prosthodontics (dentures) is included but is subject to certain limitations and exclusions. You should review this information in the Dental Schedule of Benefits located on the CMS website before beginning any course of treatment.

My spouse is losing his/her job and won't have insurance. When can I add him/her to my dental insurance?
You may add your spouse to your insurance within 60 days of the qualifying event, in this case, the termination of employment. If you do not add your spouse within this time frame, you must wait until the next Benefit Choice open enrollment period, which is typically during the month of May.

What happens to my dental insurance in the event of a layoff, illness, or other types of leave?
Your dental insurance may be continued during seasonal layoff, illness, family and medical or educational leaves without pay. The State contribution continues to be paid and the employee is billed monthly by the UPB Benefits Services office for any insurance premium formerly deducted from the paycheck. Premium bills are mailed to the home addresses of employees off the payroll. The first bill will arrive at about the same time as the first paycheck is missed and then monthly thereafter. The bill will be itemized and is due within 10 days. Failure to pay a premium bill will result in termination of the health, dental, and vision coverage until the member returns to work. Re-enrollment in some plans will be subject to evidence of good health.

What happens to my dental insurance during a period of personal leave without pay?
Members on personal leave without pay may continue coverage for up to 24 months subject to the member's payment of 100% of the premium, which includes the employer contribution. Employees on personal leave will receive monthly premium bills from the UPB Benefits Services office. Premium bills are mailed to the home addresses of employees off the payroll. The first bill will arrive at about the same time as the first paycheck is missed and then monthly thereafter. The bill will be itemized and is due within 10 days. Failure to pay a premium bill will result in termination of the health, dental and vision coverage until the member returns to work. Re-enrollment in some plans will be subject to evidence of good health.

What happens to my dental insurance when I retire?
When you retire and begin receiving a monthly annuity from the State Universities Retirement System (SURS), your State dental records are transferred to the retirement system. Your cost of insurance will be the same monthly premium as active State employees are charged. Premiums will be deducted from the monthly retirement annuity check.

What happens to my dental insurance when I resign or my appointment ends?
Coverage ends at midnight on the date your appointment ends. Persons leaving employment at the University are entitled to continue the dental coverage for up to 18 months under a Federal law referred to as COBRA. Cost of coverage is borne fully by the employee. There is no State contribution toward COBRA coverage. Notice of the COBRA Continuation Option is sent to employees by Central Management Services (CMS) soon after their resignation or appointment ending date.

Dependent Coverage

All employees electing dependent coverage must provide supporting documentation of dependent status (i.e. marriage certificate, birth certificate, etc.). Please see Dependent Documentation Requirements and Deadlines.

We will be having/adopting a child soon. How do I add this child to my health, dental, and life insurance coverage?
You may add a dependent to your health, dental, and life insurance within 60 days of the date of birth or adoption. Benefit coverage changes are effective the latest day of the date the request for change was signed, or the date the event occurred. Coverage for newborns and adopted newborns may be retroactive to the date of birth if the coverage request was made within 60 days of birth. You may add a dependent through the State Plan Changes selection in the Benefits section of NESSIE.

When can my dependents be added to my health, dental, and vision plans?
New employees may add a spouse and/or dependents within the first 10 days of employment with guaranteed acceptance into the plans. All employees electing dependent coverage must provide supporting documentation of dependent status (i.e. marriage certificate, birth certificate, etc.). The guaranteed enrollment periods are the annual Benefit Choice period in May with changes effective the following July 1, or within 60 days of a qualifying event. Examples of a qualifying event include: birth, adoption, change in marital status, death of spouse or dependent, and/or change in spouse employment status. Evidence for these changes, such as a marriage license, birth certificate, or adoption decree will be required.

How long can my child be insured as my dependent?
Children may remain insured as dependents up to their twenty-sixth birthday. Certification of a child's status as "Disabled" or "Other" is required annually. Certification of a child's status as a "Veteran Adult Child" is required annually when the child is age 26 or older. Failure to return the certification form to the campus UPB Benefits Services office will result in termination of the dependent's health, dental, and vision coverage.

Children who cease to be eligible as dependents may continue coverage on their own by paying the full cost for up to 36 months under a Federal law referred to as COBRA. It is the member's responsibility to notify the campus UPB Benefits Services office if the dependent ceases to be eligible for benefits.


Maintained by University Human Resources | Contact Information | Last Update: 01-May-2013 | ID: 75