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Eligibility
If you are a benefits-eligible employee, you may enroll for dental insurance.
You may also enroll your eligible dependents for coverage. All eligible
employees can enroll for employee only coverage, employee plus spouse
coverage, employee plus child(ren) coverage or family coverage within
31 days of their hire date or during the annual open enrollment period.
Employees also have 31 days from a qualifying event to make changes to
their coverage.
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Expense
The College pays a majority of the premium for dental coverage for you
and any eligible dependents you elect to enroll. You pay the remaining
portion of the premium expense by payroll deduction. The Tax Saver Program
lets you make these deductions on a before-tax basis. For more information
on Tax Saver, see the chapter entitled “Other Benefits.”
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About the Plan
You have a choice of how your dental benefits
are provided. You may select the Traditional
PPO Dental Plan, or, where available, the Dental
Maintenance Organization Plan (DMO). Each provides
quality service.
These two options are compared below.
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Traditional PPO Dental Plan
The Traditional PPO Dental Plan offers you and your enrolled family members
dental benefits without requiring payment of a deductible for preventative
procedures. You may use in- or out-of-network dental care providers for
treatment. For preventative work, such as exams and cleanings, this plan
will pay 100% of the cost for in-network providers, and 100% of usual,
reasonable, and customary (UCR) costs for out-of-network providers. For
basic services, such as fillings or root canals, and for major dental
work, such as dentures, the plan will pay 80% of the cost for in- network
providers, and 80% of UCR for out-of-network providers after the $50/person
or $150/family deductible has been met. The calendar year maximum benefit
for all services other than orthodontia is $1,500 per person. This plan
offers an orthodontia benefit for dependent children up to age 19 of 50%
of cost, with an individual lifetime maximum benefit of $1,000. The orthodontia
benefit applies to both in- and out-of-network providers.
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Dental Maintenance Organization Plan
The Dental Maintenance Organization (DMO) Plan does not require a deductible.
You choose your primary care dentist from a network of dental care providers
supplied by the DMO. These dentists have agreed to provide dental services
at reduced fees to DMO participants. The DMO plan covers 100% of charges
for any preventative work or basic repairs after your $5 co-pay, and 50%
to 75% of major dental work. There is no annual maximum benefit under
the DMO plan. When you enroll in the DMO you pay only your portion of
the bill. There are no claim forms to fill out and no waiting for reimbursement.
This plan also offers an orthodontia benefit for dependent children and
for adults that includes evaluation, treatment, and retention with a specific
schedule of benefits for each stage of the process. The orthodontia benefit
applies to DMO providers only.
To determine which plans are offered in your region, please visit the
College's benefits website at www.gregoryappel.com/ivytech.edu.
For complete details of the plan and the procedures
covered, please refer to your dental plan booklet.
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