 Enrollment and Effective Dates
Life Events General Information Claims
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.
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.
When does dental insurance coverage begin?
University sponsored dental insurance coverage begins the first of the month following the date of employment.
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).
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.
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.
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.
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.
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.
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.
General Information
What is a PPO Dental Plan?
It is a self insured
dental plan covering comprehensive care by dentist 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.
The PPO
plan is administered by BlueCross BlueShield of Illinois.
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.
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.
How can I find out if my dentist in the First Commonwealth provider network?
You should contact First Commonwealth directly at 312-644-1810 or view the provider list at http://www.firstcommonwealth.net.
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.
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.
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.
Are there pre-existing condition limitations if I change dental plans during Open Enrollment?
The pre-existing conditions provision does not apply.
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.
How long can my child be insured as my dependent?
Effective January 1, 2009, unmarried dependent children may remain insured
as dependents until their 26th 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.
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.
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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