Eligible Categories: Administrative, Executive, Full-time Regular Faculty, Hourly, Professional, and Regular Staff.
As a condition of participation, all employees must enroll in the Group Health Insurance Program to qualify for Dental Insurance. All eligible categories may participate in the dental insurance program currently offered through Blue Cross/Blue Shield. Benefits are provided for preventive procedures (routine cleaning and exams), basic procedures (fillings and extractions), and major procedures (crowns and dentures).
Orthodontic benefits are provided for children under 19 years of age.
The University and the employee share the cost for the dental program. The premium can be payroll deducted on a pre-tax basis.
Schedule of Benefits - Subject to the exclusions, conditions, and limitations of the coverage, a covered person is entitled to benefits for Dental Services described below during a Benefit period, subject to the Deductible, when applicable.
|BENEFIT PERIOD||Calendar Year|
|PROGRAM DEDUCTIBLE||$25 per person per Benefit Period|
|FAMILY DEDUCTIBLE||$100 must be satisfied by Covered Persons under the same Family Coverage in each Benefit Period. However, no family member will contribute more than the individual program Deductible amount.|
|COINSURANCE||0% of the Covered Expense Incurred for charges made by a Dentist up to the amount listed in the Dental Services Schedule.|
|COVERED DENTAL SERVICES|
|Preventive Services||100% up to the scheduled maximum benefit|
|Basic Restorative Services||100% up to the scheduled maximum benefit|
|Major Restorative Services||100% up to the scheduled maximum benefit|
|Orthodontic Services||100% up to the scheduled maximum benefit|
|BENEFIT PERIOD MAXIMUM FOR ALL PREVENTIVE, BASIC AND MAJOR SERVICES||$1,000 per individual per Benefit Period|
|ORTHODONTIC SERVICES LIFETIME MAXIMUM||$1,000 per eligible Covered Person* per lifetime|
*Orthodontic benefits are limited to Dependent children under the age of 19.
For more information, refer to your BC/BS Group Medical and Dental Benefits Booklet, or contact your Benefits Representative (firstname.lastname@example.org).