Dental & Vision Plans

Transcription

1 Dental & Vision Plans Contributed by GEO Friday, 08 December 2006 Last Updated Tuesday, 27 November 2007 Dental & Vision Plans GEO won a dental plan for grad employees at UMass-Amherst in our contract. Dentists do not work at UHS, nor is our dental coverage administered by UHS but by GEO and Delta Dental, thus we generally refer to the dental plan as an autonomous entity separate from our health plan. Starting in 2006, GEO added a vision care plan through EyeMed Vision Care. This page has general information about our plans--for actual plan descriptions and coverage amounts please go to GEO for an enrollment packet or you can download one at Once you have read through the information below you can enroll on-line at To help members with any questions or problems, you may contact our benefits administrator, Leslie Edwards. You can contact Leslie at uawdental@external.umass.edu or by phone (413) SOME IMPORTANT THINGS TO NOTE * Coverage for both dental and vision runs from November 1st to October 31st, so if you had dental and/or vision coverage through GEO in , you will still be covered until October 31st 2007, but new students will not be covered until November 1st 2007, assuming that you sign up before the October 10th, 2007deadline. * One of the stipulations of our contract is that everyone MUST sign up for dental every year, so if you had coverage in Fall 2006/ Spring 2007, you should do this by the October 10th, 2007deadline to avoid any gaps in coverage. BENEFITS for : An Overview IMPROVEMENTS TO PLANS INCLUDE: FAMILY DENTAL PLAN COST IS REDUCED TO JUST $100/YEAR, INCREASED DENTAL CALENDAR YEAR MAX FROM $1500 TO $2000; INCREASED TYPE III DENTAL COVERAGE TO 65%; IMPROVED VISION ALLOWANCES FOR MANY SERVICES AND PRODUCTS; AND INCREASED COVERAGE PERIODS FOR THOSE WHO GRADUATE! Costs Eligibility

2 Enrollment Coverage Options Finding Providers Dental & Vision Trust Office Location & Hours COSTS: All plans are free except Family Dental! As of our latest contract, both the GEO dental plan and the GEO vision plan are free to individuals. The exception is for those opting for dental insurance for their families. If you want family dental coverage, you must pay a premium of $100 for the year (less than $9/month). We are pleased to be able to offer Family vision coverage free of charge. If you choose to apply for Family dental coverage, you may pay your family premium using any of three methods: 1. Payroll Deduction: Your request form must be brought to the GEO office by the October 10th at NOON. $20.00 will be taken out of 5 paychecks starting October 19th. This payment option is only available in the Fall semester. 2. Credit Card: Payment is made on the web via secure server. Contact the benefits administrator for more details. 3. Check: Write a check for the full amount of $100 made out to "UAW/UMass BOT" and either bring it to the GEO office or mail it to:uaw/umass Dental & Vision Fund, 326 Middlesex House, University of Massachusetts, Amherst, MA ELIGIBILITY The eligibility criteria are very similar to those for the health insurance waiver (though the plans and their application processes are completely separate). To be eligible, you must be an enrolled graduate student (program fee is ok) at the University of Massachusetts Amherst and be working in a GEO-eligible position earning the minimums described below. Full Years' Eligibility: Earnings from June 1, 2007 through May 31, 2008 in a GEO position totaling at least $6935 (or full responsibility for teaching two three-credit course sections) make a graduate student employee eligible for dental and vision coverage for the period of November 1, 2007-October 31, If your earnings occur only in the spring semester, but will total at least $6935, you are eligible to enroll in the plans for November 1, however, your enrollment application must be accompanied by a copy of your employment contract or your letter of appointment. Six Months' Eligibility: November through April

3 Earnings from June 1, 2007 through January 12, 2008 (basically fall semester earnings) in a GEO position totaling at least $ (or full responsibility for teaching one three-credit course section) make a graduate student employee eligible for dental and vision coverage for one (1) six-month period: November 1, 2007-April 30, 2008* Six Months' Eligibility: May through October Earnings from January 13, 2008 through May 31, 2008 (basically spring semester earnings) in a GEO position totaling at least $ or full responsibility for teaching one three-credit course section) make a graduate student employee eligible for dental and vision coverage for one (1) six-month period: May 1, October 31, 2008.* Eligibility for Spring-Entering Graduate Student Employees If you enroll as a graduate student for the first time in the spring semester AND have a GEO-eligible position in spring with earnings of at least $6935 (or full responsibility for teaching two three-credit course sections) you are eligible for coverage starting with the first day of the spring semester (January 28, 2008) through October 31, If your earnings are less than $6935 but more than $ , you are eligible for one period of coverage (May 1, 2008-October 31, 2008). *In cases where an employee's contract spans both time periods outlined above such that the appropriate coverage period cannot be definitively determined, the applicant may be offered the option to choose which of the two six month coverage periods he or she would prefer. In all other cases, the employee's coverage must be designated for the six month period that overlaps the majority of their term of employment. When Graduate Employees Become Ineligible for the Plans If you graduate, you will lose your eligibility at the end of the plan period you are currently enrolled in (i.e. if you are enrolled for the spring period of the plan and you graduate on May 25, your coverage will end Ocober 31; if enrolled for the spring period of the plan and you graduate September 1, your coverage will end October 31; if enrolled for the fall period of the plan and you graduate February 1, your coverage will end April 30. If you withdraw as a student from the university, fail to be enrolled as a student, or terminate your employment prior to earning the minimum earnings required above, you will lose your eligibility thirty (30) days after the aforementioned event occurs.

4 If you lose your eligibility, you have the option of continuing your coverage for up to 18 months by paying 102% of your monthly premium, per the federal COBRA legislation) ENROLLMENT Dental & Vision Enrollment Cycle The GEO dental and vision plans run from November 1st to October 31st of the following year (unless you're only eligible for the first 6 month coverage period starting in November). This means that you will continue to enjoy full coverage in the summer (unless you graduate - see above). You must re-enroll every year. When enrollment begins (generally in the last weeks of September), s and letters go out to all eligible graduate employees. You can enroll on-line at You will also need to download a Dental & Vision FERPA waiver (sometimes referred to as an "authorization form") from the dental & vision website, to be signed and brought to the GEO office. A Dental & Vision FERPA waiver allows the union to verify your eligibility for the dental & vision plans. We cannot process your dental & vision application without a Dental & Vision FERPA waiver. DEADLINES The enrollment deadline for Nov. 1 coverage is October 10th 2007 at NOON. You must apply online and then return your signed enrollment authorization form (dental & vision FERPA) to the GEO office by this deadline. We cannot guarantee against gaps in your coverage if your application is received later than this. If you are enrolling for family coverage, and wish to pay your premium via payroll deduction, you must return your payroll deduction form by the same October 10th deadline. HOW TO APPLY STEP 1 - ONLINE: Please visit to apply for dental & vision. This site also contains useful information that may help answer your questions. In order to complete this application you will need your Social Security Number (SSN) and a UMass Student ID number. If you do not have a SSN then please contact the Benefits Administrator, Leslie Edwards: uawdental@external.umass.edu. Please write down the login and password you create for your online enrollment for use in the future.

5 STEP 2 - GEO OFFICE: After filling out the online application you will be asked to print out and sign an enrollment authorization statement which you will need to bring to the GEO office before your application can be processed. If you choose family coverage and elect to pay by payroll deduction, you will be asked to print and sign a second authorization and bring this to the GEO office as well. Completion of the online application will be followed by verification of your eligibility. It may take up to two weeks to verify your eligibility and complete your enrollment, so please be sure your coverage is in effect before scheduling an appointment. For questions regarding enrollment and benefit coverage that are not already explained on our website please contact the Benefits Administrator at (413) You may also forward your dental questions to us via at uawdental@external.umass.edu COVERAGE OPTIONS You can find the actual plan descriptions at The actual plans and their descriptions for have not been posted yet. Stay tuned! FINDING PROVIDERS To find dentists who accept Delta Dental the best thing to do is to search the live database of in-network dentists on Delta's website. NOTE: our dental plan can be used outside of Massachusetts so you may use the Massachusetts search page to make it a bit easier to find a dentist within Massachusets (any dentist in either the DeltaPremier or DeltaPreferred network accepts our plan, but there can be a difference in your copay depending on what procedure you need done: please read "The Dental & Vision Plan Options" below) or you may use the USA search page to search for a dentist in any state: just select "Delta Dental PPO Plus Premier" as your plan (this network consists of dentists who take both DeltaPremier and DeltaPreferred). To find vision care providers, you can search for a participating vision care provider at this URL: Our vision plan is accepted at University Health Services, as well as at other major chain stores in the area.

6 DENTAL PLAN - DELTA DENTAL PPO PLUS PREMIER Even with dental insurance, any dental work beyond routine preventive care will generally incur costs not covered by the plan, such as a deductible and a copayment (see the plan description) -- sometimes this amounts to a substantial sum of money. Here are some tips for keeping your costs down when possible: - Ask for a Pre-Treatment Estimate - Dental office receptionists and dentists themselves know very little about your particular insurance plan and what it does and doesn't cover. They may try to make assurances to you and may be perfectly well-intentioned, but they cannot possibly know what our plan does or doesn't cover. The only way to make sure whether or how much something is covered is to get your dentist to submit a "pre-treatment estimate" to Delta for the procedures you need done-delta Dental will then send you a letter within about two weeks to let you know how much they will cover and how much you'll have to pay. - White Fillings - when your dentist asks you if you'd rather have white fillings or silver fillings, be aware that white fillings are only fully covered for front teeth (only rarely for other teeth). And white fillings are substantially more expensive, so you will end up paying much more out-of-pocket for white fillings. If you want the white fillings you should consider asking for a pre-treatment estimate (see above). Please note that when the plan description lists coverage for "single surface only on back teeth" this does not mean that Delta will provide coverage for a single portion of a double surface on a back tooth--they will not. - DeltaPreferred is a Discount Network - When possible, you might want to see a dentist who is in the DeltaPreferred network - though our new plan gives you the freedom to choose from a much larger network than that, the percentage you will pay on procedures at a Preferred dentist will be smaller because the amount they can charge Delta is prenegotiated and smaller. In a sense, this is Delta's discount network. Note that our plan is no longer limited to Massachusetts: you can see a dentist in-network in any state. See for info on where to search for a dentist outside of Massachusetts. - Use Delta Dental's Website - You should register for member access to Delta's "e-quest" system. This will allow you to log in and check the status of your coverage; information about your recent dental visits; the results of your pre-treatment estimate requests...and more. Click over to - Important note: Delta does not cover any procedure done in a hospital, even if a Delta dentist refers you. This issue arises mainly with oral surgery - make sure your oral surgeon is covered by Delta before you go in for services. - The UMass/UAW Dental & Vision Fund cannot interceed on your behalf when it comes to disputes with your dental or vision care provider. It is best to ask lots of questions upfront and to get a pre-treatment estimate to guard against surprises.

7 VISION PLAN - EYEMED VISION CARE Our vision care plan can be used at a number of private vision care practices as well as a number of chain stores. Here are a few things to take note of: - In store promotions for vision care cannot be combined with member benefits. If you choose to use the in-store promotion, you may use you benefits for a secondary pair of glasses or contact lenses, but not for the products or services for which the in-store discount was applied. - It will take up to business days before you receive your EyeMed ID card. You can find all the information you need to use your coverage by visiting this URL: - You can access your benefit information, information about laser vision correction, locate providers, or obtain an OON claim form at this URL: (choose: "Member Access") - Notes on the plan: 1) you can only use the benefit for plastic lenses OR contacts in any given plan year, but not both. However, the frame discount is separate and you can still get the frame discount if you've already gotten contacts in the same plan year, 2) the frame benefit is a $100 allowance and then you are responsible for 80% of any balance above $100; 3) members will receive a 20% discount on remaining balance (after your coverage has been applied) at participating providers beyond plan coverage, which can't be combined with other discounts or promotional offers and does not apply to EyeMed's Providers professional services or disposable contact lenses, 4) Non-prescription sunglasses are not covered under the plan (except for the 20% discount described above). DENTAL & VISION TRUST OFFICE LOCATION & HOURS Leslie Edwards Benefits Administrator UAW/UMass Dental and Vision Trust 326 Middlesex House University of Massachusetts Amherst, MA 01003

8 ph: fax: Office hours: M T TR F 9 am-4:30 pm