General Description

The Dental Program offers coverage for dental and orthodontic expenses under the Regular Dental Plan.

For employees living or working in the network service area, coverage is also offered under an optional network plan, Dental Plan II. For employees who work at a San Diego, California, site, the optional plan is the Community Dental Network (CDN).

Overview

Regular Dental Plan Overview

Dental Plan II Overview

Network Area (Dental Plan II)

Community Dental Network (CDN)

Eligibility

YourCorp employees on the U.S. payroll who are Regular Full-time employees or Regular Part-time employees. Foreign Service Employees who do not reside in the U.S. but are on the U.S. dollar payroll are eligible for the Regular Dental Plan only.

Eligibility

Coverage for Relatives

Coverage is available for your spouse, domestic partner, unmarried Children who are under the Limiting Age or who are Disabled, and children of your domestic partner.

Eligible Dependents

Coverage Begins

Coverage begins on your first day Actively at Work, provided you enroll within 30 days of hire. If you do not enroll or decline benefits within 30 days of your initial eligibility date, you will automatically be enrolled in the Regular Dental Plan.

Rehire

Return From Leave

Dependent Coverage Begins

Coverage Ends

Dependent Coverage Ends

Amount of Benefit

Coverage is generally based on a percentage of the Usual, Customary and Reasonable (UCR) amount subject to the Plan's deductibles and maximums. For certain services, the amount of coverage depends on whether or not you use a preferred or network provider. Note that if you use a dental office (for Dental Plan II) or dentist (for CDN) that has not contracted with the Plan, no benefits are payable.

Benefits Pay Schedule

Summary Charts

Maximum Amounts

Alternate Treatment Provision

Services Covered

Various services are covered under the Plan. However, certain services are not covered or are subject to Plan limitations.

Covered Services

Exclusions and Limitations

How do I...

• Enroll?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are enrolling a domestic partner, also complete and return a Declaration of Domestic Partnership.

Enrollment Procedure

Waive Coverage/Delayed Enrollment

• Change Coverage?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are enrolling a domestic partner, also complete and return a Declaration of Domestic Partnership.

• Add a Dependent?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are adding a domestic partner, also complete and return a Declaration of Domestic Partnership Form.

Add a Dependent

• Drop Coverage or Drop a Dependent?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If your domestic partnership is ending, also complete and return a Termination of Domestic Partnership Form. If your change is due to a Change in Family Status and you are adjusting your pretax premiums outside open enrollment, also complete and return a Change in Family Status Form.

Drop Coverage

Drop a Dependent

• Find a Dentist? (OCN/PPO/CDN Only)

For a Preferred Dentist under the Regular Dental Plan, or for dentists in the Plan II network area, or for CDN dentists, contact First Health.

Health Plan Connection

Preferred Dentists

• File a Claim?

The claims procedure depends on which plan you are in and what services the claim covers.

Filing a Claim

• Find Out More about a Denied Claim?

If you have your Explanation of Benefits (EOB) which relates to the claim, it lists the reason for the denial or benefit reduction. You may contact the Claims Administrator to request a copy of the EOB, or ask one of their service representatives for a further explanation of why your claim was denied or reduced. If you disagree with the benefit payment, you have the right to appeal.

Claim Denied/Reduced

• Convert Coverage?

In general, coverage may not be converted; COBRA may be available when YourCorp-sponsored coverage ends.

COBRA Info at a Glance

• Get ID Cards?
  (I haven't received my cards)

Dental ID cards are issued only to participants in the CDN Dental option. You will receive your ID card by mail at your home approximately four to six weeks after you enroll; call the Employee Services Organization if you do not receive it.

ID Cards

Cost

For regular, full-time employees, you and YourCorp share the cost of coverage. Rates depend on your location and the number of dependents you cover. If you are an eligible part-time employee, you pay the full-time employee cost plus a pro rata portion of YourCorp's cost based on your standard scheduled work hours.

Cost of Coverage

Approvals

You should obtain a pre-determination of benefits when it is recommended under the Regular Dental Plan, or required under Dental Plan II.

Pre-determination of Benefits

For additional information:

Dental Claims Administrator