91³Ô¹ÏÍø

The Dental Benefits Plan described is made available to eligible employees.

91³Ô¹ÏÍø's Dental Benefits Program has been designed to encourage you to maintain good dental care while keeping dental care expenses at a minimum. By visiting your dentist for check-ups on a regular basis (at least once a year) and receiving prompt treatment of small disorders when they are first discovered, you will be avoiding more serious dental problems from developing at a later date. This makes good sense from both a health and financial standpoint.

The Dental Benefit Program allows you complete freedom of choice in the selection of any licensed dentist.

In addition, you are not required to submit to a preliminary examination in order to establish your eligibility or the Dental Benefits Program.

To determine if you are eligible for this plan, please contact the Office of Human Resources.

Dental Benefits Plan Schedule of Allowances (PDF)

Dental Claim Form (PDF)

Eligibility

Benefits are available to all eligible employees on the effective date of the Dental Plan. The Office of Human Resources will determine your eligibility.

New employees become eligible on the first day of the seventh month following the date of active employment.

Basic Schedule of Allowances

The Schedule of Allowances (PDF) is published on the Office of Human Resources website. For each dental procedure listed, the plan will pay the Benefit Payable or the actual charge, whichever is less.

Termination of Benefits

Dental benefits will cease on the same day of the month you are removed from the payroll, or if you fail to make the required contributions, if any, toward the cost of your benefits. There are no benefits for dental services performed after termination of coverage.

Participating Dentists

The College's dental plan is administered by Delta Dental. Please visit their website at  to find a listing of participating dentists. Select" Find A Dentist", and choose Delta Dental PPO as the network. By using a plan participating dentist, you will be able to minimize any out-of- pocket costs that may be required for your dental services.

Exclusions

The Dental Benefits Plan will not allow benefits for the following:

• Loss or theft of a denture.
• Extra duplicate prosthetic device.
• Injuries, diseases or conditions, the treatment of which is available without cost to the person treated under the laws enacted by the legislature of any State or the Congress of the United States (such as Worker's Compensation, Veteran's Compensation, etc.)
• Cosmetic dentistry.
• Oral hygiene, dietary instructions, or education programs.
• Any charge for failure to keep a scheduled appointment.
• Orthodontics.
• Any charges for appliances or restorations, other than full dentures, whose purpose is to alter vertical dimension, stabilize periodontically involved teeth or restorative occlusions.
• Any charge for completing a claim form.
• Services or supplies which do not meet accepted standards of dental practice or are experimental in nature.
• Dental disease or defect incurred or resulting from war, declared or undeclared, military or naval service to any country, riot, civil disorder, insurrection or while committing a felonious act.
• Dental mechanic or denturist, unless practicing according to applicable dental practice acts and related statutes.
• Any service or appliance received from a dental or medical department maintained by an employer, a mutual benefit association, labor union, trustee or other similar person or group.
• Any service unless rendered in connection with the care of an employee by a duly licensed dentist, and any service or appliance for which the patient incurs no dentist's charge.
• Any type of service or appliance not described in the Plan or in any Rider modifying the Plan.

Claim Administration and Questions

For questions regarding payment of claims, processing, etc. enrollees can either visit Delta Dental's website at  and create a log-in, or can contact Delta Dental's customer service at 1-800-932-0783.

If the dentist you go to is participating in the Dental Benefits Plan, it will be required that you inform the Participating Dentist of your enrollment in the College's Plan. Notification will be accomplished by presenting the Dental Benefits Identification Card that has been issued to you.

Coordination of Benefits

If you are entitled to receive benefits from another group plan, benefits under this plan will be coordinated with the benefits from any of your other group plans so that up to 100% of the "allowable expenses" incurred during a calendar year will be paid by the plans.

An "allowable expense" is any necessary, reasonable, and customary item of expense covered in full or in part under any one of the group plans involved.

A "Plan" is considered to be any group insurance benefits or other arrangement of benefits for individuals in a group which provides dental benefits or services on an insured or an uninsured basis.

The College reserves the right to obtain and exchange benefit information from any other insurance company, organization, or individual to determine the applicability of the Coordination of Benefits provisions. When an overpayment has been made, the College has the right to recover the excess amount from the individual, insurance company, or organization to whom payment has been made. In order to obtain all of the benefits available, you should file claims under each plan.