Voluntary Dental. Group Sizes An independent licensee of the Blue Cross and Blue Shield Association. 28XX1484 R04/07

Transcription

1 Voluntary Dental Group Sizes 2-19 Affordable protection for employees and their families 28XX1484 R04/07 1 An independent licensee of the Blue Cross and Blue Shield Association.

2 Meeting the Needs of Employees and Employers Highly desired benefit. When asked to rate the importance of group benefits, the majority of employees ranked dental benefits as extremely or very important. 1 Employee s Choice voluntary dental plans give them the added security and protection they want for themselves and their families. No employer contributions. If dental insurance is not in the company budget as a core benefit, voluntary dental may be the solution. Voluntary dental plans allow employers to give their employees the benefits they want with little or no cost to the employer employees pay 100 percent of the premium through payroll deduction. Employee retention. An attractive benefit package can be a priceless commodity for any company. With voluntary dental in the portfolio, employers can attract and retain skilled and productive employees who contribute positively to their bottom line. Minimal administrative worries. Employee s Choice makes it easy for employers to offer this benefit. And, since monthly premiums are conveniently deducted from payroll, employer paperwork is kept to a minimum. Why is dental care important? The wellness value of dental benefits is often overlooked; however, regular check-ups and preventive care reveal surprising information about an employee s overall health. Research shows time and again that dental problems may affect employee productivity and performance because of pain and discomfort. According to a 2000 U.S. Surgeon General s Report on oral health, working Americans lose about 164 million hours a year to dental disease or dental visits an average of 1.48 hours per worker. 2 Medical professionals have identified at least 120 medical symptoms that can be detected in the mouth during routine dental check-ups, including skin diseases, mental illness, diabetes, thyroid problems, leukemia, cancer and hardening of the arteries. 3 In fact, bleeding gums, etched enamel and other tissue changes in the mouth often are the first clues of serious health problems. More often than not, early detection of medical concerns can reduce costly healthcare in the future. 1 Customer Benefit Satisfaction Survey, Employee Benefit News (2000) 2 Oral Health America The Disparity Cavity: Filling America s Oral Health Care Gap 3 Massachusetts Delta Dental Plan PSA Campaign,

3 Type I Preventive Services No deductible Employee s Choice Group Dental 2-19 Employees Plan A Type II Basic Services Type III Major Services $50 deductible (Combined Basic and Major services) Family Maximum 3 per calendar year Type IV Orthodontic Services No deductible Coinsurance 100% Coinsurance 80% Coinsurance 50% Coinsurance 50% Routine Exams Bitewing X-rays (two sets per calendar year, one complete series per 36 months) Prophylaxis Sealants (to age 14) Fluoride Treatments (to age 19) Space Maintainers (to age 12) Certain Lab Tests Emergency Palliative Treatment Restorative (amalgam & composite fillings) Oral Surgery (extractions & impacted teeth) Restorative (inlays & crowns) Prosthodontics (dentures & bridges) Dentures & Crown Repair Periodontics (treatment of diseased gums) Endodontics (root canal & pulpal therapy) Orthodontia limited to the proper alignment of teeth Eligible insureds are: Insured dependent children under age 21 (only) No waiting period 6-month waiting period 12-month waiting period 12-month waiting period Annual Aggregate Maximum Benefits per insured (all benefits) $1,500 Orthodontic Lifetime Maximum Benefits per insured dependent child $1,000 Annual Orthodontic Maximum per insured dependent child $500 Employee s Choice Group Dental 2-19 Employees Plan B Type I Preventive Services $25 deductible per insured per calendar year Type II Basic Services Type III Major Services $75 deductible (Combined Basic and Major services) Family Maximum 3 per calendar year Coinsurance 80% Coinsurance 80% Coinsurance 50% Routine Exams Bitewing X-rays (two sets per calendar year, one complete series per 36 months) Prophylaxis Sealants (to age 14) Fluoride Treatments (to age 19) Space Maintainers (to age 12) Emergency Palliative Treatment Restorative (amalgam & composite fillings) Oral Surgery (extractions & impacted teeth) Restorative (inlays & crowns) Prosthodontics (dentures & bridges) Dentures & Crown Repair Periodontics (treatment of diseased gums) Endodontics (root canal & pulpal therapy) Type IV Orthodontic Services Not a covered benefit No waiting period 6-month waiting period 12-month waiting period Not applicable Annual Aggregate Maximum Benefits per insured (all benefits) $1,000 Orthodontic Lifetime Maximum Benefits per insured dependent child Annual Orthodontic Maximum per insured dependent child N/A N/A 2

4 How It Works When insureds receive dental services shown in the previous charts, they pay the deductible, if any, and the applicable coinsurance. For example, if an insured is enrolled in Plan A and receives preventive services, these services are covered at 100 percent of the usual, customary and reasonable charges. For a basic service, such as a filling, the insured pays the $50 deductible and any applicable coinsurances. Please see the contract for details. Benefits are subject to the annual and lifetime maximums outlined below. Benefit Maximums Employee s Choice pays the following benefit maximums: PLAN A: Annual Benefit Maximum Per Insured $1,500 Annual Benefit Maximum Per Insured Dependent Child $ 500 for Orthodontic Services Lifetime Benefit Maximum Per Insured Dependent Child $1,000 for Orthodontic Services PLAN B: Annual Benefit Maximum Per Insured $1,000 Annual Benefit Maximum Per Insured Dependent Child N/A for Orthodontic Services Lifetime Benefit Maximum Per Insured Dependent Child N/A for Orthodontic Services Eligibility and Participation Requirements Participation Requirements for Employees groups with 2 4 eligible employees: groups with 5 9 eligible employees: groups with eligible employees: 100% participation required 75% participation required 60% participation required Participation Requirements for Eligible Dependents (after valid waivers, example: other dental coverage) groups with 2 4 eligible employees: all but 1 must enroll with dependent coverage groups with 5 or more eligible employees: 50% must enroll with dependent coverage 3

5 Excluded Professions or Industries Bands, Orchestras, Actors & Other Entertainers Dental Equipment, Supplies & Labs Drinking Places (alcoholic beverages) Elementary & Secondary Schools Employers Composed 100% of Family Members Employers in Business for Less Than 12 Months Legal Services Non-Profit Organizations Offices & Clinics of Dentists Real Estate Companies Religious Organizations Schools & Educational Services Other Information Employee s Choice voluntary dental is designed for groups with 2 to 19 employees. Contact us for a specialized quote on a larger group. Employee s Choice offers Premium Only plan administration at no additional charge to any group purchasing any Employee s Choice product. Employer contribution is encouraged, but not required. A $10 monthly billing fee will be added to plans that do not use electronic billing. Dependent children are defined as unmarried children up to age 21 (up to age 25 if full-time student) who are dependent on the employee for support. Benefits are based on usual and customary fees charged in the area where services are rendered. Other Eligibility Guidelines All full-time employees working a minimum of 30 hours per week and their qualified dependents may apply. Individuals on retainer (example: attorneys, accountants, business consultants, 1099 contract employees) and members of boards of directors are not eligible. Takeover credit (for benefit waiting periods only) will be given provided the group had similar coverage in force during the prior 12 months. Late entrant penalties apply (Type I services only for initial 24 months of coverage). Effective Dates Employees must first complete and sign an enrollment card. Coverage begins on the first day of the month following enrollment. New employees may enroll within 31 days of employment or after completing any required probationary waiting periods. 4

6 late applicants Employees who do not enroll within 31 days of becoming eligible are considered late applicants. Benefits for late applicants are limited to Type I benefits (preventive services) for a minimum of 24 consecutive months. Late applicants will be entitled to full benefits beginning with the next calendar year (January 1) following 24 consecutive months of coverage. Late applicant penalties will apply. No open enrollment periods or qualifying events apply. Limitations and Exclusions Employee s Choice voluntary dental plans do not cover the following charges (for a complete list, please refer to the contract): missed appointments completion of insurance forms services for injury, sickness or disease that are covered under Workers Compensation services performed by an immediate family member or spouse certain procedures started before coverage begins and after coverage ends treatment or supplies for pre-existing congenital or developmental malformations any care, services or supplies rendered on an experimental, investigational or research basis not recognized by the dental profession or the American Dental Association treatment or services that are not medically necessary, inappropriate or cosmetic charges considered above usual customary and reasonable amounts treatment of temporomandibular disorders (TMJ) Customer Service That s Second to None! Service is our business, and member satisfaction is our top priority. Whether you have a question about a benefit, a provider or the status of a claim, our courteous customer service representatives have all your information right at their fingertips. About Employee s Choice Employee s Choice voluntary group benefit plans are designed for employers looking to expand their benefit programs without expanding their budgets. Plus, they offer the convenience of payroll deduction. These voluntary plans include: Voluntary Dental, for both Small Groups 2-19 and 20+ Groups Voluntary Group Term Life with Accidental Death & Dismemberment Voluntary High-Limit Accidental Death & Dismemberment Voluntary Short-Term Disability Voluntary Long-Term Disability This brochure is presented for general information only. It is not a contract, nor intended to be a contract. If there is any discrepancy between this document and the policy, the provisions of policy 48XX1467 will govern. 5

7 RATES Employee s Choice Group Dental 2-19 Employees Plan A Monthly Rates Premium category Area B Area C Area D ZIPs 712,713,714 and all others not in areas C and D ZIPs , 710 and 711 ZIPs 700 and 701 Two-Tier EE Only EE + Family $21.00 $59.00 $22.00 $63.00 $23.00 $67.00 Four-Tier EE Only EE + Spouse EE + Child(ren) EE + Family $21.00 $41.00 $50.00 $70.00 $22.00 $43.00 $53.00 $75.00 $23.00 $46.00 $56.00 $79.00 Employee s Choice Group Dental 2-19 Employees Plan B Monthly Rates Premium category Area B Area C Area D ZIPs 712,713,714 and all others not in areas C and D ZIPs , 710 and 711 ZIPs 700 and 701 Two-Tier EE Only EE + Family $17.00 $46.00 $18.00 $49.00 $19.00 $52.00 Four-Tier EE Only EE + Spouse EE + Child(ren) EE + Family $17.00 $33.00 $37.00 $54.00 $18.00 $35.00 $40.00 $57.00 $19.00 $37.00 $42.00 $

8 For more information on voluntary group benefit plans from Employee s Choice, contact your producer or an Employee s Choice representative. ) 7 : call: or fax: SNLQuotes@bcbsla.com 5525 Reitz Avenue Baton Rouge, LA