2009 Benelect Guide - Dental
The purpose of this guide (print pdf version) is to provide you with an overview of Benelect—the flexible benefits program at Case. This is not intended to be a comprehensive description of the benefit plans. Details of individual benefit plans are provided in legal plan documents and contracts that govern the operation of the program. Specific coverage information is contained in the individual summary plan descriptions available from the medical insurance carrier or Benefits Administration. Employees are responsible for selecting and using their benefits prudently and in the most cost-effective manner.
DENTAL COVERAGE
Under Benelect, you have access to several dental plans. Dental enrollment is open only in even-numbered years and is a two-year election. In other words, your coverage choice remains effective from January 1, 2008, through December 31, 2009. However, depending on a qualifying change of event, you may increase or decrease coverage or opt into one of the plans at any time if your spouse (equivalent) loses employer-provided dental. And, of course, new hires in odd-numbered years may elect dental coverage at their time of orientation.
DenteMax
DenteMax is a dental provider organization (DPO). With DenteMax, you may receive care from any dentist, but more of your costs will be covered if you use a dentist who is affiliated with the network. Participating dentists are searchable online at dentemax.com >> or available from Benefits Administration. DenteMax Dental Claim Form (pdf).
Below are some of the basic DenteMax coverage features. Refer to the plan booklet (pdf) for detailed coverage information.
| Basic DenteMax Features | Network Providers | Out-of-Network |
|---|---|---|
| Deductible | None | $50 for individual, $100 for family |
| Maximum Benefits | $1,500 per year per covered person | $1,500 per year per covered person |
| Preventive Care - services such as semi-annual examination and e-rays | 100% | 70% of usual,customary and reasonable (UCR) |
| Basic Care - services such as fillings extraction, oral surgery, periodontia and endodontia | 80% | 60% of UCR |
| Major Care - services such as bridgework, dentures, and crown restorations | 60% | 40% of UCR |
| Orthodontic Care - coverage available for children under age 19 only after one year of participation (adult orthodontia is not covered) | 50%, $1,250 life time benefit | 35% of UCR, $800 life time benefit |
Case School of Dental Medicine
The School of Dental Medicine (SDM) is offering two Dental Benefit Plans for 2008-2009 to all Case employees through the Benelect Program as follows:
- Basic Plan provides a number of diagnostic and preventive services which are totally covered benefits at a low monthly premium for those who do not require major care.
- Comprehensive Plan offers a full variety of services, including implants, esthetic veneers and bleaching. The care will be primarily provided by graduate dental practitioners at the School of Dental Medicine.
| School of Dental Medicine Features | Basic Plan | Comprehensive Plan |
|---|---|---|
| Deductible | None | None |
| Maximum Annual Benefit | $1,500 per year per covered person | $1,500 per year per covered person |
| Preventive Care - services such as semi-annual examination and e-rays, cleanings, fluoride and sealants (to age 18) | 100% | 100% |
| Basic Care - services such as fillings, non-surgical extraction, oral surgery, periodontia and endodontia | Not Covered | 100% |
| Major Care - services such as bridgework, dentures, and crown restorations | Not Covered | 60% |
| Orthodontic Care - coverage available for children under age 19 only after one year of participation (adult orthodontia is not covered) | Not Covered | 50%, $1,400 life time benefit |
Dental Coverage Level
As with medical, you have coverage categories from which to choose:
- Employee
- Employee + Child(ren)
- Employee + Spouse (Equivalent)
- Employee + Family
Waive Dental Coverage
If you already have or do not want dental coverage, another option is "waive."
