Frequently Asked Questions: Dental

Enrollment and Effective Dates

Can I enroll my domestic partner?

Yes. The University's health plan will cover the same-gender domestic partner of an employee. To enroll, an employee must complete a Declaration of Same-Gender Domestic Partner Relationship and a benefit enrollment form. The difference between the University and employee premium for single and family coverage is considered taxable income to the employee.


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How do I change my dental plan coverage?

Each year during Open Enrollment, you may elect to enroll in the First Commonwealth DMO dental plan, change from one dental plan to another, or add coverage for a spouse or dependent child to First Commonwealth coverage. You may also enroll in the Blue Cross dental plan. Similarly, you may add coverage for an eligible family member to the Blue Cross dental plan. Evidence of good dental condition is not required.

Changes become effective the following January 1.

At any other time a change may be made within 31 days from the date of a qualified change in family status. Examples of a qualified change in family status include: a birth, adoption, change in marital status, death of spouse or dependent, or change in spouse employment status.

After initial employment or benefits eligibility, an individual may either enroll in a health plan or switch from one plan to another only during Open Enrollment or within 31 days from a qualified change in family status.


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When does dental insurance coverage begin?

University sponsored dental insurance coverage begins the first of the month following the date of employment. Employees may begin coverage from the first date of employment by paying the total monthly premium to the University.

An eligible employee who wishes coverage effective from the date of hire may do so by paying the total monthly premium to the University.


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When can my dependents be added to my dental plan?

An employee may enroll his or her spouse and eligible dependent children within 31 days from the date of employment.

Employees may also add coverage for a spouse or children within 31 calendar days from the date of a qualified change in family status (marriage, birth, adoption, etc). Otherwise, evidence of good health is required in order to enroll dependents in Plan A at any other time.

For an employee who elects coverage from First Commonwealth and does not enroll his or her spouse or dependent children either at the time of employment or during Open Enrollment, he or she may not enroll dependents through evidence of good health.


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Do I need to be apply for Blue Cross coverage after my initial eligibility?

No. An individual does not need to apply for Blue Cross coverage after initial eligibility.


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Life Events

What happens to my insurance in the event of a medical leave of absence?

Dental plan coverage may be continued during a leave of absence without pay due to disability. The University's continues to make its contribution.


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What happens to my insurance during a period of personal leave without pay?

Members on personal leave without pay may continue coverage for up to 12 months subject to the member's payment of 100% of the premium which includes the University's contribution.


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What happens to my insurance when I retire?

When you retire, you may continue dental insurance coverage provided you are at least age 55 and have at least 10 years of continuous full-time University service at the time of retirement.


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What happens to my insurance when I resign or my appointment ends?

Persons leaving employment at the University are entitled to continue the health coverage for up to 18 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Cost of coverage is borne fully by the employee. There is no University contribution toward COBRA coverage. Notice of the COBRA Continuation option is sent to employees by the Benefits Division soon after their resignation or appointment end date.


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How can I contact my dental insurance company with a question or to change my address or to inquire about a claim?

An individual may contact representatives of the applicable insurance company to ask a question, change his or her address or to inquire about a claim. See the contact information page.


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General Information

What is PreDent?

The University's PPO dental plan is one of the two dental insurance plans offered to eligible Northwestern University faculty and staff. It is a self insured dental plan covering comprehensive care by any physician or hospital selected by a covered member. A self-insured plan refers to benefit plans which are funded by employee and employer Contributions and deposited to a trust. Claims and other plan expenses are paid from the trust. Any remaining monies at the end of the plan year are retained as plan assets.

Under fully-insured plans, contributions are deposited to an insurance company. Any remaining monies at the end of the plan year become assets of the insurance company and not the plan.

The PPO plan is administered by Blue Cross and Blue Shield of Illinois.


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What is a DMO or a DHMO?

A Dental Maintenance Organization (DMO) provides dental care from a network of dentists, generally emphasizes preventive services, and covers eligible services at 100% minus a specified co-payment, and does not require the completion of claim forms. An HMO only covers dental care services which are authorized in advance by an individual's primary care dentist.


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What are the differences between an DMO and an indemnity dental plan?

An Dental Maintenance Organization (DMO) only provides care from a network of dentists which is authorized in advance by an individual's primary care dentist. An indemnity dental plan enables participating members to receive care from any licensed dentist. Members are required to submit claim forms and the plan has deductibles and co-insurance. For more information, see the plan comparison page ( PDF) .


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How can I find out if my dentist in the First Commonwealth provider network?

You should contact First Commonwealth directly at 312-644-1810.


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Can I receive care from any dentist?

Yes. While an individual may receive care from any dentist, a DMO will only authorize care when care is either provided directly by the individual's primary care dentist or authorized in advance by the individual's primary care dentist.

Blue Cross dental plan members may receive care from any licensed dentist.


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What is co-insurance?

The term 'co-insurance' refers to the sharing of Blue Cross dental plan costs between covered individuals and the Plan. For example, when care is provided by a dentist, the plan pays 50% to 80% of eligible charges and members pay the difference.


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How do I change my primary care dentist?

To change your primary care dentist within the same dental group, all you need to do is to contact the medical group.

To change your primary care dentist to a different dental group, contact First Commonwealth.


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Are there pre-existing condition limitations if I change dental plans during Open Enrollment?

The pre-existing conditions provision does not apply to individuals who enroll in either Blue Cross or First Commonwealth during Open Enrollment.


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What do I do if I forget my card?

Many dentist's offices will contact the insurance company to get your benefit information if you forget your card.


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How long can my child be insured as my dependent?

Effective January 1, 2007, unmarried dependent children may remain insured as dependents through their 23rd birthday. 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.


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Claims

What do I do if I get a bill from my dentist?

If you are a member of Blue Cross, you should obtain a claim form ( PDF) from Blue Cross or from the Benefits Division, complete the form and submit the completed form directly to Blue Cross. If you are a member of First Commonwealth, you should contact the First Commonwealth directly.


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How much does dental insurance coverage cost?

Premium payments for dental insurance coverage are made by payroll deduction on a pre-tax basis. Individuals on an unpaid leave of absence, separated or retired pay monthly Contributions by check. Access monthly premium rates.


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