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Dental Plan with Vision
<p>The Health Alliance offers a Dental Maintenance Organization (DMO) plan to associates and their families for help with the costs of dental care. The dental plan covers treatment received from over 90% of the Greater Cincinnati area’s dental care providers. Since you are not required to select a dentist at the time of enrollment, the plan offers the flexibility to access treatment from any panel provider at any time while your plan is in effect. In addition, you are never required to obtain a referral and are not responsible for charges billed to you that exceed the plan’s usual, customary, and reasonable (UCR) fee schedule.</p> <p><strong>Who Can Be Covered</strong><br> Under the dental plan, you can choose:</p> <ul> <li>Single - you only </li> <li>Double - you and one dependent (spouse, domestic partner, or child) </li> <li>Family - you and two or more dependents </li> <li>No person may be covered at the same time as both a covered asociate and dependent or as a dependent of more than one covered associate.</li> </ul> <p> For the Dental Plan, your eligible dependents are:</p> <ul> <li>Your legally married spouse or domestic partner. </li> <li>Your or your legally married spouse’s unmarried children defined as: <ul> <li>Biological child(ren),</li> <li> Legally adopted child(ren), </li> <li>Child(ren) for whom you or your legally married spouse have documentation of legal guardianship, and </li> <li>Your handicapped children of any age, (documentation required), if they become unable to earn a living before they reach age 19, or before age 25 if they are full-time students. Application and documentation of handicapped status must be provided prior to the cancellation date that normally occurs for dependent children. Continuation of coverage is not activated until approval is made by the individual benefit plan or it's designee. </li> <li>Your non-custodial child(ren), as required by any qualified medical child support order. </li> </ul> </li> </ul> <p>Unmarried children can be covered until:</p> <ul> <li> The end of the year in which they attain age 19; </li> <li>The end of the month in which they attain age 25 if they are enrolled as full-time students, or </li> <li>The end of the month in which they are no longer enrolled as full-time students. (Note: you are required to annually submit proof of student status on your children age 19 or older.) </li> </ul> <p>Documentation may be required to establish the relationship and is required to establish full-time student status.</p> <p><strong>Coverage<br> </strong>Participation in the Dental Plan is voluntary. The following describes highlights of the plan:</p> <table width="100%" border="0" cellpadding="6"> <tr> <td width="34%"><p>Annual Deductible:</p></td> <td width="66%"><p>Individual: $50<br> Family: $150 maximum </p></td> </tr> <tr> <td><p><strong>The Plan Pays: </strong></p></td> <td><p> </p></td> </tr> <tr> <td><p>Preventative </p></td> <td><p><br> 100% (deductible does not apply) </p></td> </tr> <tr> <td><p>Basic </p></td> <td><p>80% of UCR </p></td> </tr> <tr> <td><p>Major </p></td> <td><p>60% of UCR </p></td> </tr> <tr> <td><p>Orthodontic </p></td> <td><p>50% of UCR (maximum of $1000 per person/per lifetime) Coverage to age 19. </p></td> </tr> <tr> <td><p>Annual Maximum Benefit:</p></td> <td><p>$1,000 per covered person non-orthodontic charges.</p></td> </tr> <tr> <td><p>Lifetime Maximum Benefit:</p></td> <td><p>$1,000 per covered person orthodontic charges. Coverage to age 19. </p></td> </tr> <tr> <td><p>Coordination of Benefits:</p></td> <td><p>Up to 100% of the plan’s allowable UCR fee. </p></td> </tr> <tr> <td><p>Overcharges:</p></td> <td> <p>You can not be balance-billed for fees charged above UCR. </p></td> </tr> <tr> <td><p>Claim Forms:</p></td> <td><p>None required; responsibility of your panel provider. </p></td> </tr> </table> <p>The network consists of over 800 providers. If you choose to obtain services not provided by a panel provider, you will pay the full cost for services received.</p> <p><strong>Vision:</strong> Discounted benefits for vision exams and eye wear are included with this dental plan. An updated listing of participating ophthalmologists and eyewear providers offering discounted services through the dental program is included on the Dental Care Plus Benefit Information/Provider Directory, available in your human resources department.</p> <p><strong>Cost of Coverage:</strong> You and the Health Alliance share the cost of coverage under the Dental Plan; the Health Alliance pays most of the cost. Your cost for the level of coverage (single, double or family) for a legally married spouse and dependent children is deducted on a before-tax basis from every paycheck during the covered period. If the coverage includes a domestic partner, a notarized Declaration of Domestic Partnership must be submitted each year and the cost will be deducted on an after-tax basis. Under Federal law, we must collect taxes on the amount the Health Alliance pays for coverage that includes a domestic partner. </p> <p>You also have the option of waiving coverage under the Dental Plan. If you waive coverage, however, you won't be able to enroll in the Dental Plan until the next annual enrollment unless you have a recognized work-life event.<br> </p>
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